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DENTAL 
MATERIA MEDICA AND THERAPEUTICS 

P R I N Z 



DENTAL 

MATEKIA MEDICA 

AND 

THERAPEUTICS 



With Special Reference to the Rational Application of Remedial 
Measures to Dental Diseases 



A Text Book for Students and Practitioners 



by 

HERMANN PRINZ, D. D. S., M. D. 

a 

Professor-elect of Materia Medica and Therapeutics, The Thomas W. Evans Museum and 

Dental Institute School of Dentistry University of Pennsylvania; formerly 

Professor of Materia Medica, Therapeutics, and Pathology, and 

Director of the Research Laboratory, Washington 

University Dental School, St, Louis 



THIRD EDITION 



ST. LOUIS 

C. V. MOSBY COMPANY 

1913 



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o s 



\ 



> 



Copyright, 1909, 1911, 1913, by C. V. Mosby Company. 



Authority to use for comment the Pharmacopeia of the United States of America, 
Eighth Decennial Revision, in this volume has been granted by the Board of Trustees 
of the United States Pharmacopeial Convention, which Board of Trustees is in no 
way responsible for the accuracy of any translations of the official weights and 
measures, or for any statement as to strength of official preparations. 



Press of 

C. V. Mosby Company 

St. Louis 



©CI.A354262 

/ 



PREFACE TO THIRD EDITION. 

The rapid exhaustion of the second edition of " Dental Materia 
Medica and Therapeutics" has rendered it again necessary to pre- 
pare a new edition. Comparatively few changes have been made 
in dental therapeutics within the last two years, and therefore, 
except the addition of some historical data and the correction of 
a few minor points, no changes have been made. 

It is gratifying to learn that the profession is showing a grow- 
ing interest in the pharmacologic action of drugs and in their 
rational application. The present tendency in the application of 
therapeutics is to discard the stereotyped formulas and to reverse 
the ancient custom of making "the disease fit the remedy." The 
practitioner of today is discarding untrustworthy and feeble rem- 
edies, and is depending more and more on those drugs whose 
efficacy has been established. 

The favorable reception given this book, not only in this 
country, but also in other countries in which English-speaking 
practitioners are found, has been most gratifying. 

H. P. 

Washington University Dental School, 
St. Louis, July, 1913. 



PREFACE TO SECOND EDITION. 

The rapid exhaustion of the first edition of '"Dental Materia 
Medica and Therapeutics" has rendered it necessary to prepare a 
new edition. Comparatively few changes have been made in 
dental therapeutics within the last two years, and therefore, except 
the addition of some historical data and the correction of a few 
minor points, no changes have been made in this edition. 

It is gratifying to learn that the profession is showing a grow- 
ing interest in the pharmacologic action of drugs and in their 
rational application. The present tendency in the application 
of therapeutics is to discard the stereotyped formulas and to reverse 
the ancient custom of making "the disease fit the remedy." The 
practitioner of today is discarding untrustworthy and feeble rem- 
edies, and is depending more and more on those drugs whose 
efficacy has been established. 

The favorable reception given this book, not only in this coun- 
try, but also in other countries in which English-speaking prac- 
titioners are found, has been most gratifying. It is also worthy 
of note that this book is being translated into the German lan- 
guage. 

H. P. 

Washington University Dental School, 
St. Louis, August, 1911. 



PREFACE TO FIRST EDITION. 

A systematic classification of drugs which shall answer all pur- 
poses has never been, and probably never will be, successfully 
arranged. Such a classification will, according to the standpoint 
from which the subject is treated, evince individual trend of 
thought. The chemist, for example, prefers a classification 
according to the chemic relationship of the drugs, the pharma- 
cologist is principally interested in a classification according to 
the physiologic action of drugs, while the clinician groups the 
drugs according to their therapeutic effects. The author, guided 
by extensive class-room experience and clinical practice, has made 
an effort to point out how pharmacologic research and clinical 
observations may be advantageously combined in the rational use 
of remedial agents for the purpose of favorably influencing dis- 
ease. The entire subject matter is, therefore, treated from the 
standpoint of the pharmaco-therapeutist. 

The practice of dentistry requires, in addition to specific phar- 
maceutic preparations, quite a large number of remedies which are 
seldom employed by the medical practitioner, unless used by him 
for totally different purposes. These remedies are generically 
termed dental remedies, and consequently their importance de- 
mands special discussion. To draw a definite line of demarcation 
between dental and general remedies is not only impossible, but 
is distinctly undesirable. Frequently conditions arise where a 
knowledge of general remedies is absolutely necessary for the 
dental practitioner — as, for example, the treatment of certain 
phases of pericementitis requires the administration of uric acid 
solvents, specific infection calls for cathartics, antipyretics, etc., 
and the mitigation of pain may necessitate general anodynes. 

The progress of dental pharmaco-therapeutics has not kept 
]i>ace with the remarkable advances made in the technical branches 
of dentistrv. The unsatisfactorv classification of dental remedial 
agents is largely due to a gross disregard of the progress made in 
general pharmacology arid pathology. The principal part of 

7 



8 PREFACE. 

operative dentistry is surgery, but unfortunately tne average prac- 
titioner applies the same mechanism to drug action, and, expect- 
ing too much from a drug, is frequently disappointed. 

The difficulties which presented themselves to the author in 
systematizing the subject were the many conflicting statements 
found in literature relative to the action of dental remedies. An 
effort has been made to avoid vague information and to elucidate 
only clinical facts which have been established by pharmacologic 
research. Both factors are essential in determining the true value 
of the action of a drug. The pharmaceutic descriptions of chem- 
icals and drugs, and their preparations and doses, are in con- 
formity with those given in the latest editions of the Pharma- 
copeias of the United States and Great Britain. 

The author acknowledges his indebtedness to workers in both 
general and dental pharmaco-therapeutics, and especially to the 
text books of A. Cushny, R. Robert, R. Heinz, T. Sollmann, and 
many others which he has freely consulted. He desires to thank 
his friends, Professor Carl Jung, of Berlin, for the use of the 
micro-photographs of tooth powder preparations, and Doctors 
James A. Brown and L. Neuhoff for assistance in the preparation 
of most of the original illustrations. He also acknowledges his 
obligations to the S. S. White Dental Manufacturing Company, 
Ransom & Randolph Company, Lennox Chemical Company, 
Gebauer Chemical Company, Modern Medical Company, Consoli- 
dated Dental Manufacturing Company, Wm. Meyer Company, 
R. S. Squibb & Sons, Burroughs Wellcome & Co., and Parke, 
Davis & Co. for the use of various illustrations of dental appli- 
ances. 

H. P. 

Washington University Dental School, 
St. Louis, September, 1909. 



CONTENTS 



PART I. 

GENERAL THERAPEUTICS. 

Page. 

Intkuuoction 17 

The aim of Therapeutics 25 

Action of Drugs 31 

Classification of Dental Remedies 34 

Selection of the Remedy 38 

Methods of Administering Medicines 40 

Prescription Writing 47 

Incompatibilities 58 

Weights and Measures . 61 

The Pharmacopeia and Pharmaceutic Preparations ..... 69 

PART II. 

PHARMACO-THERAPEUTICS. 

Drugs Which Exercise No Definite Action on Specific Organs. 

Antiseptics 75 

Salts ef the Heavy Metals, their Oxids, and their Organic 

Compounds 79 

The Acids, the Alkalies, the Halogens and their Derivatives . 92 

Solutions Which Evolve Nascent Oxygen ..." 106 

Antiseptics of the Aromatic Series 121 

Antiseptics of the Marsh Gas Series 136 

Essential Oils, their Derivatives, and their Synthetic Substi- 
tutes 155 

Astringents 171 

Metallic Astringents 173 

Vegetable Astringents . 181 

Caustics 184 

Liquid Caustics 187 

Dry Caustics 188 

Hemostatics and Styptics 217 

Absorbents 219 

Caustics and Astringents 219 

Agents Which Act After Being Absorbed Into the Circulation 221 

Agents Which Act on tha Vessels, but Not on the Blood . . 221 

9 



10 CONTENTS. 

Page. 

Protectives, Demulcents, and Emollients 223 

Irritants and Counterirritants 228 

Antacids 236 

Drugs Which Act on Specific Organs. 

Drugs Which Act on the Mouth and Teeth. 

Bleaching Agents 238 

Preparations for the Mouth and Teeth 245 

Mouth Washes .256 

Tooth Powders 260 

Tooth Pastes 269 

Tooth Soaps 271 

Drugs Which Act on the Peripheral Nerves. 

Local Anesthetics and Obtundents 272 

Soluble Local Anesthetics . 275 

Insoluble Local Anesthetics . 284 

Refrigerant Local Anesthetics 289 

Drugs Which Act on the Central Nervous System. 

General Anesthetics 292 

Physiologic Action of Nitrous Oxid 298 

Administration of Nitrous Oxid 299 

Physiologic Action of the Anesthetics of the Methan Series . 305 

Administration of Ethyl Chlorid 319 

Preparation of the Patient 324 

Choice of the Anesthetic 324 

Treatment of Accidents of General Anesthesia 325 

Hypnotics 332 

Anodynes 334 

Sedatives 340 

Cerebral Stimulants . 342 

Drugs Which Act on the Gastro-Intestinal Canal. 

Stomachics and Digestives 345 

Emetics , 350 

Cathartics 353 

Drugs Which Act on the Circulation. 

Circulatory Stimulants and Depressants .'" :, . 360 

Drugs Which Act on the Respiration. 

Respiratory Stimulants and Depressants . 366 

Drugs Which Act on Metabolism. 

Tonics 368 

Alteratives 375 

Drugs Which Act on the Secretions. 

slalogogues and antisialogogues 380 

Diaphoretics ...... « 383 

Diuretics . 384 

Uric Acid Solvents 386 



CONTENTS. 11 

Drugs Which Act on the Temperature. 

Antipyretics . 393 

Organo and Serum Therapy. 

Organo Therapy. 398 

Serum Therapy 400 

PART III. 

PHYSICAL THERAPEUTICS. 

Artificial Hyperemia 405 

Massage 423 

Light and Radio Therapeutics 427 

Heat and Cold 431 

Plugging Bone Cavities with Inert or Medicated Substances . 435 

PART IV. 

LOCAL ANESTHESIA. 

History 443 

Means of Producing Local Anesthesia 447 

Physiologic Action of Anesthetics 448 

Local Anesthetics 458 

Hypodermic Armamentarium 464 

Technique of the Injection 471 

Side and After Effects of Local Anesthetics and Their Rela- 
tion to the Penal Code 505 

APPENDIX. 

Diagnosis of Diseases of the Pulp by the Electric Current . 513 

Urine Analysis 523 

Immediate Treatment of Acute Poisoning 529 

Glossary of Therapeutic Terms 534 

Diagnostic Aids 538 

Thermometry Equivalents 539 

Dose Table 540 






ILLUSTRATIONS. 

Figure. Page. 

1 Ground-Glass Cover Bottle 37 

2 Salt-Mouth Bottle 37 

3 Dental Applicator 38 

4 Fac-Simile of a Correctly Written Prescription 50 

5 Culture Plate, with Gold Cylinders and Foil 80 

6 Imaginary Diagram of a Solution of Mercuric Chlorid in Water . 82 

7 Liquid Soap Dispenser 100 

8 Minim Syringe for Applying H2O2 Solution 110 

9 Pyrozon Probe Cup 112 

10 Oxygen Inhalation Apparatus 113 

11 Portable Oxone Generator, closed 114 

12 Portable Oxone Generator, open 115 

13 Aseptic Absorbent Paper Points 151 

14 Silver Nitrate Applied to Carious Dentin, low power . . . . • . 194 

15 Silver Nitrate Applied to Carious Dentin, high power 195 

16 Action of Silver Nitrate on Dentinal Fibrils 196 

17 Action of Silver Nitrate on Living Dentin 197 

18 Adjustable Silver Nitrate Pencil 199 

19 Dental Mustard Plaster in Position 234 

20 Electric Heater and Spray Outfit 256 

21 Magnified Specimens of Tooth Powder Substances 262 

22 Magnified Specimens of Tooth Powder Substances 263 

23 Magnified Specimens of Tooth Powder Substances 264 

24 Magnified Specimens of Tooth Powder Substances 265 

25 Apparatus for Making Nitrous Oxid 297 

26 Soft Wood Mouth Props 300 

27 Semi-Solid Rubber Bite Blocks • 300 

28 Lawrenz Adjustable Mouth Prop 301 

29 Nitrous Oxid Gasometer 302 

30 Nitrous Oxid Gasometer, sectional view 303 

31 Universal Gas Stand for Nitrous Oxid 304 

32 Surgeon's Portable Nitrous Oxid Apparatus 305 

33 Universal Gas Stand 306 

34 Coleman's Nasal Inhaler 307 

35 Teter Combination Gas Stand 308 

36 Nitrous Oxid Inhaler, with celluloid hood 309 

37 Teter Nasal Inhaler . 310 

38 Simplex Inhaler, sectional view . 310 

39 Brown Anesthetizer, ready for administration 311 

40 Brown Anesthetizer, a nitrous oxid and oxygen combination outfit 312 

41 Ethyl Chlorid Dropping Tube 319 

42 Ferguson Inhaler 320 

13 



14 ILLUSTRATIONS. 

Figure. Page. 

43 Ethyl Chlorid Tube 321 

44 Ermold-Stark Inhaler, sectional view 321 

45 McFarlane's Ethyl Chlorid Inhaler , 322 

46 Gebauer Combination Inhaler 323 

47 Artificial Respiration, expiration 328 

48 Artificial Respiration, inspiration 329 

49 Tracing the Blood Pressure under Synthetic Suprarenin .... 365 

50 Dun Bifluorid Syringe • 391 

51 Schematic Drawing of an Abscess 408 

52 Suction Cups for Abscesses About the Cheeks, Lips, and Chin . . 413 

53 Suction Cup for Alveolar Abscesses About the Gums 414 

54 Application of the Elastic Bandage 415 

55 Application of a Suction Cup 417 

56 Hyperemic Suction Cup Applied to a Chin Fistula 418 

57 Suction Cup Applied to a Fistula on the Cheek 419 

58 Hyperemic Suction Apparatus for the Treatment of Pyorrhea 

Alveolaris . 421 

59 Dental Vibrator 426 

60 Dental Electric Light 428 

61 Dobrzyniecki's Heat and Light Reflector 429 

62 Mode of Application of the Therapeutic Lamp 431 

63 Electric Thermaphone Pad 434 

64 Bohm's Syringe for Bone Plombe 437 

65 Collapsible Tube for Bone Plombe 438 

66 A Hypodermic Syringe Prepared for Bone Plombe 439 

67 Bone Plombe in Position 440 

68 A Large Cavity in the Mandible Filled with Bone Plombe .... 442 

69 Plasmolysis of Cells of Tradescantia Discolor 449 

70 Ethyl Chlorid Spray Tube, glass 453 

71 Ethyl Chlorid Spray Tube, metal 454 

72 Application of the Ethyl Chlorid Spray 455 

73 Glass Dish for Mixing Anesthetic Solution 461 

74 Dropping Bottle 462 

75 Glass Measure for Local Anesthetics . 463 

76 Hermetically Sealed Glass Ampuls of Various Types 464 

77 "Sub-Q" All-Glass Syringe 465 

78 Aseptic All-Glass Syringe 466 

79 Manhattan All-Metal Syringe '. '. 467 

80 All-Metal Syringe 468 

81 Dental Hypodermic Needle Points 470 

82 Hypodermic Needles of Various Designs 470 

83 Needle Attachment for Parke, Davis & Co. Syringe 471 

84 Cross Section of a Right Lower Jaw 473 

85 Horizontal Section Through the Alveolar Process of the Lower Jaw 474 

86 The Nerve Supply of the Upper and Lower Jaw 475 

87 The Nerve and Blood Supply of the Hard Palate 476 

88 Position of Needle for Injecting About an Upper Central Incisor . 477 

89 Position of Needle for Injecting About a Lower Incisor .... 478 



ILLUSTRATIONS. 15 

Figure. Page. 

90 Position of Needle for Injecting About an Upper First and Sec- 

ond Molar 479 

91 Position of Needle for Injecting About an Upper Third Molar . . 480 

92 Position of Needle for Injecting About a Lower Third Molar . . 481 

93 Position of Needle for Injecting the Mandibular Nerve .... 485 

94 An Abnormal Course of the Mandibular Canal 487 

95 Loeffler's Pressure Syringe Attachment for Anesthetizing the 

Pulp 492 

96 An Aqueous Solution of Eosin Forced Through Dentin .... 493 

97 Section Through the Root of a Molar 495 

98 Points for Pressure Obtunding Syringe 496 

99 Weaver High Pressure Obtunding Syringe 497 

100 Anesthetizing a Small Tumor by Rhomboid Injection ..... 503 

101 Section Through an Anesthetized Tumor . 504 

102 Typical Small Faradic Battery 516 

103 Dental Electrode 518 



PART I. 
GENERAL THERAPEUTICS. 



INTRODUCTION. 

The practice of medicine is as old as the human race. How- 
ever crude the efforts may have been, we are justified in believ- 
ing that men have tried to render assistance to their fellowmen 
in case of illness. Most likely these first attempts were principally 
of a surgical nature, and only later internal diseases received 
attention. In due time the natural instinct inherent in both 
man and beast led to the utilization of the products of the imme- 
diate surrounding — primarily of herbs and plants, and later of 
animal drugs. It became a part of the sympathetic duties of 
woman to look after the ills of the family. Close observation 
and practice enlarged the circle of medical vision, and "the 
wise woman of the clan'' originated, of which we find even today 
isolated specimens. With the progress of civilization and the 
entering of religion into the routine duties of the daily life, 
diseases were mostly regarded as punishments from the gods, and 
it was left to the priests to look after both the mental and the 
bodily welfare of their community. In the less cultured the 
curing of disease consisted in administering mysterious concoc- 
tions, accompanied by the hocus-pocus of the conjuror, a rem- 
nant of which we find in the present practice of the medicine 
man of the Indians. With the evolution of the races the prac- 
tice of selecting suitable remedies for certain diseases became a 
matter of systematic observation and study. Instinctive em- 
piricism selected a number of remedies which were especially 
suited for its purposes — those which were used to remove certain 
dangerous symptoms, or to bring about and strengthen other 
symptoms which apparently hqd a beneficial influence upon the 

17 









18 GENERAL THERAPEUTICS. 

disease. Irritants and counterirritants applied externally and, 
to some extent, internally were probably the first therapeutic 
attempts of influencing diseased conditions. They were followed 
by those remedies which mitigate irritation and allay inflamma- 
tion, and finally by those which alleviate pain. Popular medi- 
cine is the foundation of scientific therapeutics of all nations. 
Naturally, the remedial agents differ with each nation. Sys- 
tematic search for new remedies was introduced much later as 
a result of close observation of the action of certain drugs. For 
example, quinin, obtained from the cinchona tree, was used 
by the Peruvians in fever, especially in malaria. It was brought 
to Europe by the Spaniards in 1550, and forms one of the most 
important constituents of the present materia medica. Its physio- 
logic action on the malaria parasite was discovered by Binz in 
1868. Again, the use of oil of cloves as a toothache remedy is 
of an old and unknown origin, and it has been only recently dis- 
covered that it owes its anesthetic properties to p-amidobenzoic 
acid, a chemical which is closely related to some of the modern 
synthetie cocain substitutes. 

The early history of dental medicine is so closely interwoven 
with that of medical therapeutics that it is impossible to dis- 
tinguish it from its mother science. The Babylonians, Egyptians, 
Assyrians, Hebrews, Hindus, Greeks, and Romans were the early 
cultured inhabitants of whom historical records exist. The re- 
cent excavations in Babylon have brought to light some interesting 
facts concerning the practice of dentistry under King Ham- 
murabi, at about 2150 B. C. The law stated that "if one knocks 
out a tooth of one of his caste, his own tooth shall be knocked 
out, while, if it is the tooth of a freeman, he pays one-third mine 
silver." The Egyptian medical history is principally recorded 
in the various papyri, especially those of Ebers and of Brugsch, 
which probably cover the period of 3700 -to 1500 B. C. The 
Egyptian physicians were largely specialists, and it is very prob- 
able that some were selected to look after the welfare of the teeth. 
Most of the dental remedies found in the papyri consist of pastes, 
powders, plasters, decoctions, etc., in which St. John's bread, sage 
seed, honey, and some unknown plants play important parts. 



INTRODUCTION. 19 

The treating of abscesses, caries, and loose teeth seems to have 
been known. The Hindus were apparently very proud of their 
teeth. It is recorded that the use of tooth powders and washes, 
and especially the use of the tooth pick, "rinacarya," were neces- 
sities of their daily toilet. As a tooth pick they employed a bitter 
tasting Avood, which was chewed, producing a fibrous bundle, 
which was then used as a brush for the gums and the teeth. A 
tooth brush of this very same nature has been recently introduced 
in the United States and in Great Britain. In the writings of 
Hippocrates and Pliny frequent allusion is made to drugs which 
were especially advocated for diseases of the teeth and the mouth. 
With the simpler remedies — as hyssop, licorice, dog's milk, goat's 
butter, etc. — many disagreeable substances, especially of the ani- 
mal kingdom, were recommended. In Pliny's writings we find, 
among other dental suggestions, that "if one wishes to be free 
from toothache, one should eat a whole mouse twice a month." 
The tooth powders and lotions which were prescribed by the Greek 
physicians consisted principally of mixtures of burnt hartshorn, 
marble dust, wood ashes, burnt saltpeter, etc., and solutions of 
honey, aromatic vinegars, spiced wines, etc. Among the cultured 
Romans and Etruscans the care of the mouth and teeth consti- 
tuted an important item of their personal hygiene. The mouth 
preparations were principally represented by powders, pastes, and 
washes. Quite a variety of formulas for such, preparations are 
found in the writings of Celsus, Scribonius Largus, Galen, Ser- 
vilius Damocrates, Apollonius Archistrator, and others. The re- 
moval of deposits from the teeth by skilled persons and the mak- 
ing of artificial substitutes for the lost organs were apparently 
ordinary occurrences. It seems that the artifex medicus dentium, 
the dental surgeon of the Romans, did not practice the mechanical 
part of his profession. Judging from the writings of Celsus, this 
was left to the man who dealt in other orthopedic supplies, such 
as surgical instruments, crutches, etc. In the laws of the twelve 
tables (A. D. 303) special reference is made regarding the use 
of gold about the teeth. It was stated that the gold employed 
for such purposes did not have to be removed prior to cremation. 
It is also of interest to note that in the epigrams of Martialis 



20 GENERAL THERAPEUTICS. 

many allusions are made to the teeth and their care. So we 
read, for instance : 

Esse quid hoc dicam, quod olent tua basia myrrham? 
How do I explain it that your kiss smells after of myrrh? 

Myrrh, which was brought from Asia Minor and Egypt, seems 
to have been quite a favorite mouth preparation with the Roman 
ladies. Aside from its use as a mouth wash, it was also applied 
in combination with other fragrant gums as mouth pastilles 
(cachous) : 

Ne gravis hesterno fragres, Frescennia, vino 

Pastillas Cosmi, luxuriosa, voras. 

That the breath of your mouth may not smell from yesterday's wine, 

Frescennia, you use Cosmus' mouth pastilles. 

Artificial teeth seem to have been quite fashionable with the 
Roman dames, as the following would indicate : 

Dentibus atque comis, nee te pudet, uteris emtis; 

Quid fades oculo, Laelia? Non emitur. 

Without shame you make show with bought teeth and hair; 

But what about the eye, Laelia; can one buy this also? 

Specimens of Etruscan dentistry in the form of bridges, crowns, 
bands, etc., are still preserved in the National Museum of Naples. 

The patron saint of dentistry, St. Apollonia, was canonized in 
Rome about 300 A. D. Being a Christian, St. Apollonia was 
tortured by her persecutors by having her teeth, one by one, ex- 
tracted, and finally suffered death by fire. Her memory is com- 
memorated on February 9th of each year. Remains of her skele- 
ton are preserved in the various churches of Rome, Naples, 
Cologne, Antwerp, Brussels, and Quebec, and excellent pictures 
of the saint by Guido Reni, Carlo Dolci, and others are found 
in Milan, Florence, and other cities. The name of St. Apollonia 
is frequently mentioned in prayers in the various prayer books 
of the middle ages, and is especially intended for the relief of 
toothache. 

Comparatively little progress in dentistry is to be recorded dur- 
ing the middle ages. Arabian and Persian medicine was at its 
height during the ninth to the twelfth centuries, and the names 



INTRODUCTION. 21 

of Mesue, Abulcasem, Avicenna, Avenzoar, etc., will always occupy 
important places in dental history. The influence of religion 
on scientific matters in general during the medieval age im- 
pressed its stamp of retardation also indelibly on dentistry. Dur- 
ing this period dentistry' had probably sunk to its lowest ebb, and 
became the handicraft of vagabonds, who traversed the countries 
from one end to the other, practicing medicine and dentistry in 
its crudest form. The professional charlatan, who represented 
himself as a "tooth puller," barber, and leech and theriac vender, 
was a familiar figure in the market places of the big cities or at 
the annual fairs of the smaller towns. The extraction of the 
aching tooth was incidentally a source of sale of some tooth 
preparation or an amulet for the prevention of the occurrence of 
pain in the remaining teeth. Lay medicine found a prolific field 
in the treatment of diseases connected with the teeth, and the 
many books on medical witchcraft that were published princi- 
pally during the twelfth to the seventeenth century usually de- 
voted quite a little space to dental ailments. A most interesting 
collection of prayers, incantations, popular remedies, and other 
matters pertaining to dental folklore is found in Kummel's little 
book, "Die Gute Alte Zeit." 1 

The final resurrection of dentistry from its lowest plane and 
its rehabilitation as a part of medicine is to be credited to 
Fauchard, who, through the publication of his work, "Le Chi- 
rurgien Dentiste, ou Traite des Dents," in 1728, gave the incentive 
for renewed activity on practical, as well as theoretical, researches 



1 Kiimmel: Die Gute Alte Zeit. Kulturbilder der Geschichte der Zahnheilkunde, Berlin, 
1907. A few examples taken from this book will illustrate the nonsensical incantations that 
were thoughtlessly blabbered for the relief of toothache: 

O St. Apollonia, I stand here as a poor sinner, whose teeth are full of pain. Ee reconciled 
and give me rest in my bones, that I may forget the ache in my teeth. Amen. 

I greet thee, new moon; 

For the .pain and for the gout, 

And for the three little worms 

Which are in my teeth; 

One gray, one blue, and one is red, 

I wish that all three now were dead* A,r>en. 

There are three holy women— 

The first is called Ann, 

The second Susan, 

The third Sybille; 

O toothache, stand still! Amen. 



22 GENERAL THERAPEUTICS. 

in dental science. Prior to 1840 comparatively few important 
communications on dental surgery had appeared. The foremost 
literature of this time was published in France and England, and 
a few books of importance appeared in Germany. The United 
States was at this period principally concerned with the practical 
development of this new branch of the healing art, and, with 
the exception of the writings of Longbotham, E. -Parmly, L. S. 
Parmly, Flagg, Trenor, Fitch, Bostwick, Spooner, S. Brown, the 
Burdells, and others, little was printed in relation to dentistry. 
Dental text books, if used at all, were imported from England, 
or translations of French works were published. Koecker, a 
practitioner of international reputation, pictured the situation 
quite correctly when he stated, in 1826, that "in the United 
States, although little or nothing has been done in the way of 
publishing on the subject of dental surgery, yet I feel myself 
authorized to say that in no part of the world has this art ob- 
tained a more elevated station." It must also be remembered 
that the individual practitioner of this period was extremely 
jealous of any special knowledge which he happened to possess, 
and he usually guarded this acquired proficiency very carefully. 
No specific current dental literature was in existence at that time, 
and comparatively few medical journals tried to disseminate the 
progress of medical and, incidentally, dental knowledge. The 
few journals were seriously hindered in this laudable cause by the 
extreme difficulties of interchange on account of the very limited 
facilities of the postal service. The first dental periodical of this 
or any other country appeared in 1839 under the name of "Ameri- 
can Journal of Dental Science," and was published by E. Parmly, 
E. Baker, and S. Brown. The first regularly organized dental 
society of any importance was the "American Society of Dental 
Surgeons," which was founded in New York on August 18, 1840, 
with Horace H. Hayden as president. The birth of dentistry as 
a distinct and definite profession may be recorded simultaneously 
with the dale of incorporation of the first dental college of the 
world, the Baltimore College of Dental Surgery, which received 
its charter in 1839. Its first session commenced in the follow- 
ing year, with a faculty composed of Horace A. Hayden, Chapin 



INTRODUCTION. 23 

A. Harris, Thomas E. Bond, and H. Willis Baxley. Medicine 
and dentistry were from that year practically divorced, and, while 
dentistry in its early days depended very largely on medicine for 
its further development, it bases its fundamental studies at pres- 
ent on general biology exactly in the same manner as medicine, 
veterinary medicine, or any other branch of the healing art is 
forced to do. 

Arkovy has said that "in operative dentistry, empiric thera- 
peutics has reached far ahead of pathologic knowledge." The 
truth of this axiom finds its explanation, as we have stated above, 
in an absence of organization of the comparatively few dental 
practitioners prior to 1840. No specific books on dental remedies 
were then in existence, and the little knowledge concerning the 
action of drugs was scattered through the few dental works, or it 
was closely guarded by its possessor. Since then quite an ex- 
tensive literature on dental materia medica and therapeutics has 
appeared, which furnishes ample proof of the immense stride 
made, especially in the last decade, in this particular phase of 
dental science. 1 The drugs which were principally applied as 



1 The more important literature on dental materia medica and special therapeutics covering' 
the period from 1829 to 1909 is represented by the following text books: Fitch: Pharmacy Con- 
nected with Dental Surgery, in "A System of Dental Surgery," Vol. Ill, New York, 1829; Bond: 
A Practical Treatise on Dental Medicine, Including an Inquiry Into the Use of Chloroform and 
Other Anesthetic Agents, second edition, Philadelphia, 1852; White, J. W.: Dental Materia 
Medica, Philadelphia, 1868; Stock en: Elements of Dental Materia Medica and Therapeutics, with 
Pharmacopeia, third edition, London, 1882; Thamhaym: Arzneimittellehre fur Zahnarzte, Stutt- 
gart, 1883; Flagg and Foulks: Quiz Questions— Course on Dental Pathology and Therapeutics, 
Philadelphia, 1885; Ingersol: Dental Science— Questions and Answers on Dental Materia Medica, 
Dental Physiology, Dental Pathology, and Therapeutias, Keokuk, 1886; Thomson: Formulaire 
Dentaire— Maladies et Hygiene de la Bouche et des Dentes, Paris, 1886; Leffmann: Materia 
Medica and Therapeutics, in "The American System of Dentistry," Vol. Ill, Philadelphia, 1887; 
Hollander und Schneidemiihl: Handbuch der Zahnarztlichen Heilmittellehre, Leipzig, 1890; 
Kleinmann: Recept-Taschenbuch fur Zahnarzte, fourth edition, Leipzig, 1891; North: Questions 
and Answers on Dental Pathology and Therapeutics, etc., Springville, la., 1891; Clifford: Manual 
of Recitations in Materia Medica, Pharmacy, and Therapeutics, Chicago, 1892; Glassington: Dental 
Materia Medica, Pharmacology, and Therapeutics, London, 1896; Roy: Therapeutique de la 
Bouche et des Dentes, Hygiene Buccale et Anesthesie Dentaire, Paris, 1897; Greve: Heilmittel- 
lehre fur Zahnarzte, Stuttgart, 1898; Burchard: A Text Book of Dental Pathology and Thera- 
peutics, including Pharmacology, first edition, 1898; Gabell and Austen: Notes on Materia Med- 
ica, Pharmacology, and Therapeutics for Dental Students and Practitioners, London, 1902; 
Elander. Uppslagbok vid Receptskrifning for Tandlakare och Studerande, Goteborg, 1902; 
Warren." A Compend of Dental Pathology and Dental Medicine, Philadelphia, 1903; Viau: 
Guide Practique et Formulaire pour les Maladies de la Bouche et des Dentes suivi du Manuel 
Operatoire de 1' Anesthesie par la Cocaine en Chirurgie Dentaire, third edition, Paris, 1904; 
Pharmacopeia and Formulary of the Royal Dental Hospital of London, London, 1905; Greve: 
Diagnostisch-Therapeutisches Taschenbuch fur Zahnarzte, Frankfurt, 1906; Long: Dental 
Materia Medica, Therapeutics, and Prescription Writing, Philadelphia, second edition, 1908; 



24 GENERAL THERAPEUTICS. 

dental remedies were usually such agents as were also employed, 
according to their therapeutic indications, for disturbances of a 
similar pathologic nature in other parts of the body. Prominent 
among these remedies are the commoner astringents — nutgalls, 
oak bark, myrrh, alum, etc. Of the caustics, silver nitrate and 
the mineral acids, especially nitric acid, were much in vogue. 
Arsenic trioxid has always occupied an important place in den- 
tistry as a powerful caustic. In 1836 it was recommended by 
Shear jashub Spooner 1 for the purpose of destroying the dental 
pulp, and, in spite of the many substitutes offered, it still main- 
tains an enviable reputation for this purpose. Creosote, and to a 
still greater extent phenol (carbolic acid), which w T as discovered 
by Runge in 1834, have always been favorite remedies, which 
were employed as caustics, obtundents, and, unwittingly, as anti- 
septics. The antiseptic era was, however, inaugurated by Joseph 
Lister many years later. Its birthday may. be registered at 1867, 
when Lister read his epoch-making paper on "The Antiseptic 
Principle in the Practice of Surgery." Many of the essential 
oils — the oils of cloves, cinnamon, peppermint, spearmint, turpen- 
tine, etc. — have been employed for many centuries as obtunding 
agents in the treatment of pulpitis, and they have always enjoyed 
quite a reputation as flavoring agents for mouth preparations. 
Aromatic and analgesic fomentations consisting of cataplasms pre- 
pared from mixtures of chamomile, henbane, poppy heads, hops, 
ground linseed, or roasted figs and bruised raisins, occupied a 
prominent place as antiphlogistics for the relief of inflammation 
about the teeth and their adnexa. Of the true analgesic drugs, 
opium and aconite are probably the most important representa- 
tives. Among the aromatic tinctures and lotions which were 
used as soothing and healing mouth washes, alcoholic extracts 
of balsams and resins — as myrrh, frankincense, benzoin, mastic, 
etc. — and decoctions and infusions of herbs, barks, and roots — 

Paschkis: Materia Medica, in "Handbuch der Zahnheilkunde," by Scheff, third edition, Wien 
und Leipzig, 1908; Biberfeld, Arzneimittellehre fur Studierende der Zahnheilkunde und Zahn- 
arzte, Berlin, 1909; Gorgas: Dental Medicine— A Manual of Dental Materia Medica and Thera- 
peutics, eighth edition, Philadelphia, 1909; Ramon Pons: Compendio de Patalogia y Terapeutica 
Odontologicas, second edition, Madrid, 1909. 

1 Shearjashub Spooner: Guide to Sound Teeth, or a Popular Treatise on the Teeth, New 
York, 1836. 



AIM OF THERAPEUTICS. 25 

as arnica, anise seed, cloves, cinnamon, chamomile, sweet flag, 
ginger, merigold, scurvy grass, mallow, sage, etc. — were in com- 
mon use. Innumerable formulas for tooth powders are found 
in the older works pertaining to the treatment of the teeth, and 
consisted largely of a base made from prepared chalk, burnt 
oyster shells, charcoal, crabs' eyes, Armenian bole, pumice stone, 
etc., mixed with cuttlefish bone, magnesia, vegetable powders, 
especially spices, and coloring materials. 

A record concerning the more important events of the develop- 
ment of dental pharmacology would be incomplete if the dis- 
covery of general anesthesia were not mentioned, even if it is 
only en passant. To the dental profession of the United States 
belongs the honor of having introduced into surgery the first 
practical method of obtaining complete anesthesia. The dis- 
covery of anesthesia is the greatest boon ever bestowed on man- 
kind for the relief of suffering. With the introduction of nitrous 
oxid gas as a general anesthetic in 1844 by Horace Wells, the 
stimulation for further researches was initiated, and the future 
development of anesthesia was merely a sequence of this incentive. 

THE AIM OF THERAPEUTICS. 

The object of medical art is to cure disease, to relieve suffering, 
and to maintain health. Aside from the various technical means 
employed in relieving the sick, there are at the service of the 
physician hygienic and physical measures, and the use of a num- 
ber of substances which, when applied to or introduced into the 
body, bring about decided changes. These substances are known 
as drugs. The rational administration of drugs depends on a 
clear conception of their physiologic action. It is supposed, 
however, that the physician possesses a comprehensive knowledge 
of the causes which produce disease — general pathology — and 
that he utilizes this knowledge together with that of the physio- 
logic action of drugs in the struggle of combating disease. 

The materials and substances used in medicine comprise the 
animal, vegetable, and mineral kingdom; and the study of their 
names, sources, physical character, and chemic properties, their 



26 GENERAL THERAPEUTICS. 

preparations, doses, etc., is referred to as materia medica. The 
term materia medica was introduced by Dioscorides (40-90 A. D.) . 
He published the first (so far as known) compilation of descrip- 
tions of about a thousand drugs, which were mostly vegetable in 
character, while the first collection of prescriptions — a formu- 
lary — was edited by Scribonius Largus about 100 A. D. Drugs — 
pharmaca — are remedies ; the study of drugs — that- is, the changes 
which are induced in the living organism by their administra- 
tion — is known as pharmacology. In a restricted sense of the 
word, only the changes which are produced by the action of 
drugs in the healthy or diseased organism is known as pharma- 
cology, while the power of drug action itself is known as 
pharmacodynamics. At the present time pure pharmacology is 
classified as a department of biology; all biologic sciences, how- 
ever, serve in some form or another as handmaids to general 
medicine. In the teaching as well as in the clinical application 
of pharmacology a number of questions arise which indicate its 
close relationship to physiology and to pathology. Through the 
action of drugs on normal tissues we are led to understand their 
effects on the disturbed functions of these tissues. In the ex- 
perimental study of antipyretics, for instance, their influence on 
the normal temperature as well as on the increased temperature 
in fevers, together with an understanding of the nature of the 
latter, is essential for the full comprehension of their therapeutic 
application. In its broadest conception, then, we understand by 
pharmacology the science of the changes which occur in the 
vital reactions of healthy and diseased tissues under the influence 
of chemic substances. The application of remedial substances in 
the treatment of diseased conditions of the body is based on our 
knowledge of pharmacology, and it is at present referred to as 
pharmacotherapy, a term which was introduced by Robert 
(1887). It constitutes the most important branch of thera- 
peutics. Some substances, when injected into the living body, 
possess little medicinal value, but they act as poisons by bring- 
ing about dangerous or even fatal results. The study of their 
effects on the tissues and the methods of their detection is known 
as toxicology. It is difficult to draw a distinct line between a 



AIM OF THERAPEUTICS. 27 

drug and a poison; frequently only the quantity given and the 
method of its administration will determine whether the sub- 
stance acts as a food, a drug, or a poison. The description of the 
drugs, their habitats, their composition, and their recognition is 
spoken of as pharmacognoscy , while pharmacy is usually defined 
as the art of preparing medicines for use and dispensing them 
on the order of the therapeutist. The term pharmacy is also 
applied to the place of business of the druggist ; the latter is also 
known as pharmacist or apothecary. The application of reme- 
dial measures for the purpose of relieving the sick and favorably 
modifying the evolution of disease is referred to as therapeutics. 
While in the past the administration of remedies was largely 
based on empirical experimentation, modern research endeavors 
to employ rational methods for the treatment of diseases. A 
few diseases are directly amenable to drug action — as malaria, 
syphilis, anemia, etc. — and the remedies employed for such dem 
nite purposes are known as specifics. Unfortunately only a very 
few of these specifics are at our command, and all of them were' 
discovered by empirical medication. Within recent years rational 
methods have been adopted for the treatment of certain infec- 
tious diseases, which resulted in the discovery of definite, specific 
products known as antitoxins, which act against the disease pro- 
ducing toxins very much in the same manner as an antidote 
acts against a poison. It is to be hoped that this truly marvelous 
development of organo-therapy will lead to the discovery of fur- 
ther specific sera which may aid in the battle against some of 
the greatest scourges of the human race. 

It is not always possible to reach the diseased organ directly 
by the administered remedy — that is, to remove the causative 
factors of the disease. Sometimes it will be found that a disease 
has progressed so far as to exclude direct medication. The thera- 
peutist may, however, be able to relieve the painful symptoms, 
or he may at least mitigate the conditions. Symptomatic treat- 
ment is frequently of great benefit to the patient; the latter is 
principally interested in getting relief from things which annoy 
him, and he cares less about things which may be harmful. The 
physician must be able to judge from the symptoms which he 



28 GENERAL THERAPEUTICS. 

recognizes in the diagnosis of the disease what remedies are best 
indicated for his patient; he must know the best method of their 
administration, their dose, the length of time they should be 
given, etc. If a disease has altered, or even destroyed, a part of 
certain tissues or their functions, it does not necessarily follow 
that a permanent injury must result, provided that the work 
of the diseased organ is carried on by some other organ. A 
kidney may become so affected that its removal is indicated. 
This does not necessarily mean that the patient has to succumb, 
as the other sound kidney is sufficiently active to carry on the 
work which nature had intended for the two organs, and the 
patient may still enjoy fairly good health. When, however, an 
organ is so altered by a disease that its work can not be accom- 
plished by another organ — for example, the valves of the heart 
have become weakened — drugs may be administered which will 
beneficially influence the symptoms of this diseased condition, 
but they will never cure the ailment. 

Etiologic and symptomatic therapeutics will be, more or less, 
always applied simultaneously. It should not, however, be under- 
stood that the symptoms of diseases, even if they cause more or 
less annoyance to the patient, should be treated at once by drug 
administration. These subjective disturbances are frequently 
reactive measures of the organism created for the purpose of 
destroying the disturbing elements. It is immaterial whether 
these disturbances are the cause of the disease or its product. 
At present fever is generally considered a means of self-defense 
of the disturbed organism, and is instituted by nature against 
the micro-organisms which have gained access to the tissues. 
Nature may, however, in her efforts to battle with the invading 
foe, go too far, and the fever may rise above 104° F. (40° C), 
and, as a consequence, will endanger not only the disease pro- 
ducers, but also the heart. It is now the duty of the physician 
to regulate the activity of self-medication by the body and keep 
it within proper channels by the application of suitable remedies. 
Again, in inflammation, which is at present recognized as a reac- 
tion of the tissues against an injury, the preliminary hyperemia 
is one of the foremost means of self-defense that the body pos- 



AIM OF THERAPEUTICS. 29 

sesses. The application of antiphlogistic^ is usually counter- 
indicated in the early stages of the disturbances; if the pain that 
accompanies an inflammatory condition becomes unbearable, then 
it is the duty of the physician to counteract the eager efforts of 
nature by applying carefully selected remedies that will keep it 
within proper limits. 

While modern medicine has profited extensively by its associa- 
tion with pharmaceutic chemistry, it should not be forgotten that 
the old and well-tried remedies — as opium, mercury, potassium 
iodid, digitalis, etc. — still hold an important place in the arma- 
mentarium of the conscientious physician, and that they are as 
yet not supplanted by the so-called modern substitutes. It is a 
false illusion that only the new is valuable and reliable, and the 
old is a relic of the past. On the other hand, it should be remem- 
bered that there still prevail a great many notions regarding the 
action of certain remedies which are not in harmony with the 
modern rational conception of the physiologic action of drugs. 
Some of these "pharmacologic fetishisms," as they have been very' 
appropriately called by a writer, are so deeply implanted in the 
minds of some practitioners that the latter have become slaves 
in the blind following of this belief. For instance, the idea of 
administering potassium chlorate with the intention of exerting 
a beneficial influence on all forms of diseases in the mouth by the 
liberation of nascent oxygen is wholly unfounded. Potassium 
chlorate is principally a blood poison, and as a therapeutic agent 
it possesses no advantage over any other simple salt, as sodium 
chlorid. Again, potassium iodid and sulphureted lime are lauded 
by many as panaceas in the treatment of disturbances arising 
from general infection. As a matter of fact, neither of these 
chemicals is indicated as a specific in these conditions. Sul- 
phureted lime has no place in modern therapeutics, and potassium 
iodid possesses only one real indication, and that a most important 
one — in certain stages of syphilis. 

Quite frequently the question is asked, "Do drugs ever cure?" 
Before an attempt is made to answer this question it is necessary 
to have an understanding of what constitutes a "cure" and, inci- 
dentally, what is meant by health and disease. It does not mat- 



30 GENERAL THERAPEUTICS. 

ter for our present consideration from which point of view we 
look upon life. To us it means the reaction of cell activity of the 
organism as a whole produced by various external agents. When- 
ever the normal equilibrium of this cell activity is disturbed by 
a morbific cause, the organism reacts against it, producing a series 
of phenomena which is known as disease. Nature possesses as 
an inherent quality the power of re-establishing normal condi- 
tions — vis medicatrix naturae — i. e., to heal the disease. To aid 
nature in the reconstruction of her disturbed functions, the physi- 
cian applies remedial agents which are intended to "cure" the 
disease. Expressed in the words of Celsus, these two processes 
are denned as natura sanat, medicus curat. In the layman's 
mind there is not the remotest doubt that a drug or a combina- 
tion of drugs possesses the power of producing a cure. He takes 
a headache powder with the definite expectation of curing his 
headache. This very idea is still entertained by a number of 
practitioners of the old school. Since the first publication of 
Virchow's Cellular Pathology in 1858, and the consequential ad- 
vances made in experimental pharmacology, this prevalent notion 
has greatly changed. It was shown that the drugs themselves had 
no direct influence on the disease itself. As soon as this fact be- 
came known it was quite fashionable to laugh at the curative 
effects of drugs, thus establishing the folly of drug nihilism with 
certain erratic physicians. This drug skepticism frequently re- ■ 
suits from errors regarding the medicines themselves, or from im- 
proper utilization of drugs — at the wrong time or in the wrong 
disease — or their definite action is not distinctly understood. Un- 
familiarity with the fundamental principles of incompatibility is 
quite frequently another cause of drug nihilism. While we are 
aware that the vis medicatrix naturae is the profound basis of a 
cure, we are also aware that the action of the drugs is materially in- 
strumental in coaxing nature to bring about a change in the pre- 
vailing conditions. Numerous instances could be cited to elucidate 
this tenet. The physician administers quihin to his patient to 
kill the 'plasmodia malarise, the true cause of malaria, but the 
many disturbances which the malaria germs have produced in the 
various organs of the body are restored by nature. The dentist 



ACTION OF DRUGS. 31 

removes a tooth which is the cause of a purulent infiltration of 
the soft and hard tissues, but the restoration of the distorted tis- 
sues and the healing of the wound is accomplished solely by 
nature. Or, a man breaks his jawbone, and the skillful dental 
surgeon puts the broken parts in proper position, applies a splint, 
and the parts unite without leaving the least trace of a deformity ; 
but without nature's reparative process — without formation of the 
callus — the best surgical skill would be of no avail. Such in- 
stances are met in very old people, in whom, in spite of the best 
treatment, fractured parts refuse to unite. On the other hand, 
without having the parts put in proper position, a great deformity 
may result, or the fracture may remain ununited in spite of a 
superabundance of nature's reparative power. 

The young graduate, fresh from college, usually starts out 
with a long list of drugs, ready to combat all diseases. When 
he gets his first patient with some difficult ailment, where drug 
administration is indicated, he finds that the remedy which he 
has chosen is utterly incapable of influencing the existing condi- 
tions ; his faith receives a severe shock, and usually tumbles down 
to a disbelief in drug action. A small number of drugs, meeting 
the every-day indications, should be employed in the bulk of a 
dentist's work. Constant acquaintance familiarizes him with their 
nature and their uses, and with these few remedies his best work 
is usually done. Therapeutic nihilism is just, as erroneous as 
the polypharmaceutic shotgun prescription of our ancestors. 
Practitioners of large experience usually obtain the best result 
with a few of the simple remedies, while many of the younger 
disciples of Esculapius seize after new compounds because they 
do not know how to employ either of them. "When called to 
guide, a patient through an illness, the physician should be con- 
stantly a watchman, and a therapeutist only when necessity' 



arises." 



ACTION OF DRUGS. 

The action of drugs on the organism is known only in a very 
few instances. After a drug is absorbed by the tissues, a chemic 
reaction between this substance and the protoplasm of the cell 



32 GENERAL THERAPEUTICS. 

occurs, which is generically expressed as irritation. What consti' 
tutes this irritation and its subsequent reaction with the diseased 
organism is as yet unknown. Two definite factors apparently 
play an important role in the therapeutic action of drugs — first, 
the power possessed by the drug itself, and, second, the reactive 
power possessed by the organism. Recent experimental observa- 
tions seem to point to the fact that pathologically altered tissues 
react quite differently to chemic substances than do normal tis- 
sues, and that the condition of the organism, within certain limits, 
determines whether the same pharmacologic action will produce 
good or bad results. The irritation produced by the absorbed 
drug manifests itself as stimulation or as depression of the func- 
tion of the organism. These reactions depend largely on its 
dose and on the age, sex, and individuality of the patient. Some 
drugs, when ingested in small quantities, increase the bodily 
functions, while, when taken in large doses, decrease the same 
function. Again, certain drugs exercise specific influence on cer- 
tain organs. All changes which occur within the tissues as a 
result of the action of a drug are of a chemic nature. Usually 
three forms of reaction between the drug and the cell of the 
body are recognized: 

1. A superficial combination between the cell wall and the 
chemic substance occurs, which lasts as long as the cell is active 
and is not injured. The chemic substance does not enter into 
the protoplasm of the cell proper. 

2. A combination of the chemic substance and the cell con- 
tents is produced as a result of the easy penetration of the sub- 
stance into the protoplasm proper. 

3. A combination is formed between the chemic substance and 
the protoplasm which lies intermediate between the first and 
second group — that is, it may require minutes, or even days, be- 
fore this combination is obtained. 

Nature will always hold its own as far as the supremacy of 
drug influence is concerned — it will always react against drug 
action as long as it possesses vitality. If the tissue does not 
possess sufficient strength to resist the action of the drug, death 
is the result, while, if the diseased tissue wins the battle by in- 



ACTION OF DRUGS. 33 

creased reaction against the drug, it will return to its normal 
function. 

All drugs that are ingested into the body are again removed 
from it by the secretions and excretions. This process depends 
largely on the stability of the union which the drug has formed 
with the tissues. Some drugs show a predilection for certain 
glands for their removal — as, mercury is largely removed by the 
salivary glands, potassium iodid through the glands on the 
mucous membrane of the eyes, etc. 

The remarkable achievements made by the progress of or- 
ganic chemistry has materially aided the rapid development of 
pharmaco-therapeutics. The discovery of the active constituents 
of plants, the alkaloids, and their preparation in a pure state 
has furnished the physician with a great many very important 
medicinal agents, which are now used by him in preference to 
the crude drugs. The discovery of the chief alkaloid of opium — 
morphin — by Sertiirner, in 1816, marked a new era in pharma- 
ceutic chemistry. It was rapidly followed by the discovery of 
atropin in belladonna leaves, cocain in coca leaves, strychnin in 
mix vomica, etc., and at present there are probably very few 
medicinal plants of which the active constituents have not been 
isolated. These alkaloids allow an accurate dosage, and, to in- 
crease the rapidity of their action, Alexander Wood, in 1855, 
introduced an important change in their administration — -the 
hypodermic method. The analysis of the alkaloids has led the 
way to the discovery of a number of synthetic compounds which 
proved to be, in some instances at least, superior to the action 
of the natural alkaloids in the treatment of disease. For instance, 
after the chernic constituents of cocain had been positively 
worked out, various groupings of the original molecules, with 
certain additions and omissions, furnish the many synthetic 
cocain substitutes which since have proved to be of even greater 
value than the original cocain. This is also true of many anti- 
pyretics, antiseptics, diuretics, diaphoretics, and a host of similar 
synthetic substances. 

The newer remedies which have been introduced into materia 
medica within the last forty years owe their discovery almost 



34 GENERAL THERAPEUTICS. 

exclusively to the chemic laboratory. They were discovered, not 
by accident, but by definite, previously outlined experimental 
work. The introduction of chloral hydrate as a hypnotic by 
Liebreich, in 1869, was probably the first step in modern experi- 
mental pharmacology. Lauder Brunton, in 1867, introduced 
amyl nitrite for the purpose of lowering the blood pressure; in 
1884 Filehne discovered antipyrin, which was soon followed by 
acetanilid, phenacetin, and the many other antipyretics. Not 
alone had plant alkaloids to furnish their quota of remedial 
agents, but the various glands of the animal had to give up their 
active constituents for the treatment of disease. In 1894 Oliver, 
Schafer, and Moore discovered the blood pressure raising principle 
of the suprarenal capsules, and since then a number of similar 
organo preparations have found their way into modern therapy. 

CLASSIFICATION OF DENTAL REMEDIES. 

The largest group of the medicinal substances that are used 
by the dentist in his clinical practice are drugs that exercise no 
definite action on specific organs. The disturbances of the oral 
cavity that lie within the province of the dental practitioner are 
principally of an infectious nature, and consequently the agents 
that are employed to combat septic influences — the antiseptics — 
form the most important group of dental remedies. Antiseptics, 
in their action, are so closely related to caustics and astringents 
that it is often merely a question of quantity (concentration of 
the solution), and not of quality, that governs the primarily 
desired effect. All precipitants of albumin are classed as astrin- 
gents, and in relatively concentrated solutions they act as caustics. 
Hand in hand with the destruction of the protoplasm of the cell 
of the individual goes the destruction of the unicellular organisms 
found in or about the cell — the bacteria— and as a consequence 
these same remedial agents act in most cases incidentally as anti- 
septics. Again, astringents, when applied to bleeding surfaces, 
exercise specific functions which are designated as hemostatic or 
styptic action. Aside from their chemic action, hemostatics or 
styptics often afford mechanical protection to the denuded sur- 



CLASSIFICATION OF DENTAL REMEDIES. 35 

faces, and they are therefore closely related to protectives and emol- 
lients. In connection with the protectives we may class those 
agents which remove the exciting cause of disturbance — antacids, 
irritants, and counterirritants. To restore the normal equilibrium 
of the oral cavity, and incidentally to act purely for cosmetic pur- 
poses, the many mouth specialties — washes, powders, pastes, soaps, 
bleaching agents, etc. — are employed. 

Aside from their general action, certain drugs exercise specific 
functions on definite organs or sets of organs — on the peripheral 
nerves, the central nervous system, the gastro-intestinal canal, the 
circulation, the respiration, metabolism, the secretions, etc. Most 
of the morbid disturbances and almost all of the operations which 
form an integral part of the work of the dental surgeon are accom- 
panied by more or less pain. To be able to relieve pain is one of 
the greatest triumphs of modern pharmacology, and the remark- 
able achievements of present day conservative dentistry are largely 
to be credited to the possibilities of mitigating pain. Hence local 
anesthetics, general anesthetics, and, in the broadest sense of the 
word, hypnotics, anodynes, and sedatives, deserve a detailed dis- 
cussion. The mouth is the main gateway to the body; diseases 
present in the mouth may, under certain conditions, be the cause 
or the result of disturbances of its continuity — the gastro-intestinal 
canal. The more important functions of this continuity must be 
understood by the broadminded dental practitioner, and he should 
possess a fair knowledge of those drugs which influence the respec- 
tive pathologic disturbances — stomachics, emetics, cathartics, etc. 
Changes in the circulation which, according to conditions, require 
either depressants or stimulants, and those which influence respira- 
tory activity necessitate for their treatment certain drugs which 
form an integral part of the general pharmacologic knowledge 
possessed by. the dentist, The influence of the latter groups of 
drugs is especially of significance in the administration of anes- 
thetics and other powerful poisons. A fair acquaintance with 
drugs that exercise special functions on tissue changes — tonics, 
alteratives, etc. — and on the secretions of the body — sialogogues, 
diaphoretics, diuretics, uric acid solvents — is necessarily of 
importance. 



36 GENERAL THERAPEUTICS. 

Within recent years so-called biologic therapeutics — the use of 
animal products or those obtained from bacterial activity — have 
become powerful adjuncts to modern materia medica. These 
therapeutic possibilities are classed under the general heading of 
organo and serum therapy. While our knowledge of biologic 
products is still in its infancy, an acquaintance with their general 
principles and their possibilities in the treatment of specific dental 
ailments — pyorrhea alveolaris — is essential to the progressive prac- 
titioner. 

In addition to the administration of drugs, the treatment of 
dental lesions frequently requires other remedial applications, 
which are classed, for want of a better term, as physical thera- 
peutics. The most remarkable achievements attained with Bier's 
hyperemic treatment in general diseases has led to its adoption in 
dental surgery, and the truly astonishing results produced by it 
leads us to believe that it will play an important role in the future 
practice of oral therapeutics. The application of massage, light, 
heat, cold, and other physical measures as therapeutic considera- 
tions, as well as the plugging of bone cavities with inert or medi- 
cated materials, which has been recently introduced, should also 
be fully understood. 

It should be remembered that a presentation of a record of the 
action of drugs and their application, and other remedial meas- 
ures which are to be used by the dental practitioner, are treated 
from the viewpoint of the pharmaco-therapeutist — that is, it is the 
object of the author to show how pharmacologic research and 
clinical observation may be advantageously combined in the 
rational consideration of the use of remedial agents for the purpose 
of favorably influencing diseased conditions. Consequently no 
definite line of demarcation can be drawn between the various 
groups. The chief divisions are so arranged as to best serve the 
clinical practitioner, and not the theoretical pharmacologist. To 
facilitate the ready comprehension of the various classes, an intro^ 
duction explaining the general action of the remedies under dis- 
cussion precedes each group of remedies. 

The drugs used by the dentist in his clinical practice are usually 
of a very potent nature. On an average, only minute quantities 



CLASSIFICATION OF DENTAL REMEDIES. 



37 



are employed in a single application. To obtain the best results 
from the pharmacologic action of drugs, it is essential to procure 
the purest materials obtainable. For many reasons it is good 
policy to order drugs in original containers from a reliable manu- 
facturer. Drugs and chemicals that are obtained from an open 
stock have frequently deteriorated. For example, the essential oils 
are usually found to be thi^k, viscid, and discolored ; oxygen com- 
pounds may have lost most of their oxygen from frequent expo- 
sures to moist air ; zinc oxid may have changed to zinc carbonate 
by absorbing carbonic acid from the air ; coal tar creosote is often 
substituted for beechwood creosote ; cresol is more or less always 
of a poor quality ; formaldehyd solution has often lost most of its 
gaseous constituent, etc. 





Figure 1. Figure 2. 

Office Preparation Bottles. Figure 1, ground-glass cover bottle; Figure 2, salt-mouth bottle. 

Drugs, chemicals, pharmaceutic preparations, etc., must be 
carefully stored if one wishes to preserve their potency. The origi- 
nal containers should be kept in a cool place, protected from light. 
The office preparation bottles are preferably selected from stock 
made of colored glass — blue, green, or amber color — to keep out 
the rays of light. For liquid and semi-solid preparations the 
ground-glass cover bottles (Figure 1), which are wide-mouthed, 
are best adapted, while for dry materials the glass stoppered salt- 
mouth bottles (Figure 2) are very serviceable. Office prepara- 



38 GENERAL THERAPEUTICS. 

tion bottles may now be procured with indestructible labels, 
which materially assists in keeping the containers neat in ap- 
pearance. In using drugs or chemicals, the necessary quantity 
is preferably placed on a glass slab or a watch crystal, and then 
applied, instead of dipping the instrument directly into the bottle. 
This latter method is especially to be condemned with regard to 
anesthetic solutions, adrenalin solution^, and other liquids which 
are easily contaminated or decomposed. For applying the various 
solutions of powerfully acting drugs — phenol-sulphonic acid, 
iodin, silver nitrate, etc. — the author advises a looped iridio- 




FlGURE 3. 

Dental Applicator. 



platinum wire inserted into a metallic handle, which is readily 
sterilized in an open flame. By bending the wire in the desired 
direction, any tooth surface in the mouth may be reached. A 
number of these applicators of various sizes should be kept on 
hand for convenient use. 

SELECTION OF THE REMEDY. 

After the diagnosis of a disease is made, the proper remedy 
is selected. Depending on the nature of the disease, a psychic, 
a physical, a hygienic, a surgical (mechanical), or a pharma- 
cologic method is chosen for the treatment of the ailment. 
Usually a combination of two or more methods is employed. No 
sharp line of demarcation can be drawn between the various 
groups of remedial agents, and a division of the whole subject 
matter therefore meets with difficulties. Medicine is not an ab- 
stract science — it has its fashions and its schools. In the early 
days of medical practice the Greek and Roman schools were 
predominating, and the pharmacologic treatment consisted prin- 
cipally of the use of innumerable pharmaceutic compounds of 
vegetable drugs, which to this day are known as galenic prepara- 
tions (named after Galen, the celebrated Greek physician, who 



SELECTION OF THE REMEDY. 39 

lived in Rome, 131-201 A. D.). The Arabian physicians con- 
tinued the same practice, but added to the materia medica a 
number of new organic and inorganic compounds, which were 
prepared by their chemists or were accidentally discovered by 
the alchemists. With the introduction of iatrochemistry into 
medicine by Paracelsus, the galenic preparations and the methods 
of treatment of the Greek and Arabian physicians received a 
severe setback. When on St. John's Day, in 1527, Paracelsus 
burned publicly on the market place of Basel the works of Galen, 
Celsus, Avicenna, and others, exclaiming, "I have burnt all these 
books so that all misery may be carried away with their smoke," 
a new era had dawned in scientific medicine. During the 
seventeenth and eighteenth centuries a complete change of the 
practice of therapeutics was inaugurated, which started 
almost simultaneously in various parts of Europe. Sydenham, 
of London (1660) ; Boerhaave, of Leyden (1720) ; Van Swieten, 
of Vienna (1745) ; Hoffmann, of Halle (1725), and Stahl, of 
Berlin (1730), were the most influential reformers, and their 
names are indelibly inscribed on the historic pages of the prog- 
ress of modern therapeutics. The growing tendency of over- 
drugging received a severe check through the introduction of 
Hahnemann's (1810) method of treating diseases with very 
small doses, which, combined with other extreme changes in 
therapeutics, resulted in the foundation of the homeopathic 
school. No definite knowledge regarding drug action had be- 
come available to the practicing physician, and, as a consequence 
of the empiric administration of drugs, it became customary to 
poke fun at those who regarded drugs necessary in the treat- 
ment of diseases. Especially Skoda and Dietl (1830 to 1870), 
of the Vienna school, expressed erratic views in regard to drug 
medication, and both extremists carried the idea of drug nihilism 
to such an extent as to almost eliminate materia medica from 
the curriculum of the study of medicine. Dietl was wont to 
express his extreme skepticism regarding the action of drugs in 
this dogmatic statement, "There are no real therapeutics — there 
are only lucky physicians." Bearing in mind the fact that no 
tangible knowledge of pharmacology existed at that time, our 



40 GENERAL THERAPEUTICS. 

judgment of these outbursts of overzealous minds is materially 
modified when we consider that even at this day the drugless 
"Christian scientist" and the supporter of the "Emmanuel move- 
ment" hold sway over the minds of the credulous. 
, A systematic classification of drugs according to their pharma- 
cologic action was finally introduced by Buchheim (1870) and 
Schmiedeberg, and their classic researches form the basis of 
modern therapeutic conceptions. To designate the various meth- 
ods of therapeutic measures, the term iatro ( from the Greek 
iatros, the physician) is used as a prefix in signifying its con- 
nection with the healing art. 

Therapeutic methods may be conveniently divided into : 

1. Physical Therapeutics, or Iatwphysics. — They include the 
physical and hygienic means and methods employed as reme- 
dies — as light, heat, cold, electricity, climate, exercise, and health 
resorts. 

2. Mechanical Therapeutics, or Iatromechanics. — They are rep- 
resented by massage, gymnastics, orthopedics, and the instruments 
utilized in the performance of surgical operations. 

3. Psychologic Therapeutics, or Iatropsy chics. — They are prin- 
cipally concerned with the psychologic influences exercised by the 
physician on the patient. Especially are nervous diseases amena- 
ble to this method of treatment, although certain bodily functions 
may also be materially influenced by the method. 

4. Chemic (Physiologic) Therapeutics, or Iatro chemistry. — 
They include the feeding, the many spas, and, finally, the great 
mass of drugs proper. 

METHODS OF ADMINISTERING MEDICINES. 

Medicines may be administered by any of the accessible tissues 
or cavities of the body, and the mode of administration very often 
determines the effect of the remedy. In general, remedies may 
be applied locally, or topically, and internally. The former are 
usually intended to produce local effects, while the latter, through 
their absorption into the blood, produce general action. Relative 
to the general action of drugs, it should be remembered that a 



METHODS OF ADMINISTERING MEDICINES. 41 

drug must be in solution or in vapor form to produce its action, 
a fact which was known to the older medical chemists and dog- 
matically expressed as corpora Hon agunt, nisi soluta. The solu- 
tion which brings the drug to interact with the protoplasm of 
the cells should be so constituted as to be readily soluble in the 
body juices. Consequently the quickest action of a drug is ob- 
tained when it is dissolved in a physiologic salt solution. In cer- 
tain cases retarded absorption is important, and therefore colloidal 
substances, and sometimes fatty substances, are added to the solu- 
tion. Retarded action usually goes hand in hand with prolonged 
effects. The physiologic action of drugs depends, however, also 
on diffusion, osmosis, and other factors which control cell activity. 
Substances which are insoluble in the body fluids act only in- 
directly or not at all — that is, certain pure metals pass unaltered 
through the body. It must be remembered that insolubility in a 
physiologic salt solution does not mean insolubility in the body 
fluids. For example, calomel is insoluble in the former, but must 
be soluble, to some extent at least, in the fluids present in the in- 
testines, as it produces definite action in the intestinal canal. 

Local action of remedies is expected when they are applied to 
the skin, to the mucous membrane of the alimentary, respiratory, 
and genito-urinary tracts, to the eye. and to the teeth. The skin is 
protected with the horny layer of the epidermis and with seba- 
ceous secretions, which prevent the ready penetration of aqueous 
solutions. Oily or fatty substances mix readily with the sebaceous 
matter of the skin. If friction is applied, the substances may 
penetrate through the outer layer and even into the deeper struc- 
tures. Diffusible and volatile substances — as chloroform, ether, 
alcohol, essential oils, etc. — penetrate comparatively quickly and 
may reach the blood. The application of remedies to the skin 
with the object of producing general action is largely discarded 
at present, although inunctions with mercury ointment is still in 
favor with some practitioners. Remedies applied to the skin to 
produce local effects are principally used to act on some local dis- 
turbance. Blisters, poultices, liniments, plasters, powders, lotions, 
collodions, etc., are examples of local medicaments. Occasionally 
absorption of the drug will occur, and general action is produced. 



42 GENERAL THERAPEUTICS. 

The mucous membranes quickly absorb aqueous solutions of 
drugs, while fatty substances have very little action on these 
tissues. If an ointment is applied, the moist surface must be pre- 
viously carefully dried. Mucous membranes are much more sus- 
ceptible to drugs than the unbroken skin, and very quick action 
is usually obtained in the mouth from their ready absorption, as 
the rich blood supply of the oral tissues favors ready dissemina- 
tion. In applying solutions to the -sensitive mucous surfaces, it 
should be remembered that isotonic solutions produce the least 
irritation. If the drugs themselves do not produce an isotonic 
solution, the addition of one percent of sodium chlorid readily ac- 
complishes the purpose. The application of remedies to the mucous 
membranes, with the exception of those of the stomach and the 
intestines, is principally intended for their local action. Drugs 
are administered as solutions, paints, powders, mixtures, solids, or 
in vapor form. Diseases of the mouth and throat are treated 
with mouth washes, gargles, paints, lozenges, powders, and, some- 
times, salves. Inhalations of vaporized medicines are also used 
in the treatment of oral disease. For the latter purposes a paraffin 
vehicle is not advisable. The mouth washes are employed with a 
gargling motion. (See Mouth Washes.) Paints should be ap- 
plied with a tooth-pick wound with cotton, and caustic or corrosive 
liquids with a glass rod, or preferably with a small looped iridio- 
platinum wire. Powders are often used with a powder blower (in- 
sufflator), and powders having starch as a base are used with 
some advantage in the oral cavity. They absorb moisture and 
form a mucilaginous cover over the diseased surfaces. Small plas- 
ters over the roots of the teeth are frequently used. The mucous 
surfaces should be carefully dried prior to an application. Poul- 
tices in the form of cut figs or raisins, steeped in hot water, are 
placed over an offending tooth root, and held in place by the 
cheeks or lips. The application of medicines to the teeth is of a 
specific nature and is referred to in the discussion of the various 
remedies. The larynx and pharynx are treated by inhalation, in- 
sufflation, and by applications made with probes, syringes, etc., 
and the nasal mucous membrane receives its medication through 
douches, insufflations, bougies, and specific applications. The 



METHODS OF ADMINISTERING MEDICINES. 43 

treatment of the other mucous surfaces — conjunctiva, bladder, 
urethra, etc. — is of no special interest to the dental practitioner. 

The alimentary canal is the most common route for the ad- 
ministration of remedies. The remedies that are given by the 
mouth may act locally on the stomach and intestines, or they may 
act by being absorbed into the blood. Most remedies are given 
in aqueous solution, or in mixtures, emulsions, etc., for the pur- 
pose of increasing their ready absorption. Nauseous, ill-tasting 
medicines, or those prepared for special purposes or for conven- 
ience, are given in pills, powders, capsules, cachets, confections, 
troches,, etc. Relatively speaking, medicines are slowly absorbed 
from the stomach. They are usually diluted with the gastric 
juice, unless they chemically interact with it, and are gradually 
passed into the small intestines, where absorption takes place, 
depending on certain conditions. Oils and fats pass in most cases 
unaltered through the stomach, and are emulsified and changed 
further by the pancreatic juice. If it is intended to protect the 
medicines against the action of the gastric juice, they are usually 
adminstered in pill form and coated with some substance that is 
insoluble in the gastric fluids — as keratin, salol, etc. Occasionally 
indications arise that prohibit the administration of remedies by 
the mouth. Disturbances of this nature may interfere with the 
act of swallowing — as stricture of the esophagus, gastric or in- 
testinal diseases, surgical procedures, etc. 

The mucous membrane of the rectum, is sometimes selected as a 
means of absorbing remedies and foods. Substances soluble in 
water, or those which may be transformed into soluble materials, 
are preferably employed for such purposes. An injection into the 
rectum (enema, clyster) varies in quantity, and depends on the 
specific purposes for which it is intended. A nutrient enema 
usually measures from four to six ounces, while simple injections 
intended for local action may measure from one-half to two pints. 
Glycerin injections, which are strongly irritating when used in 
large quantities, are usually given in one to two-dram doses. \ 

The hypodermic method is usually applied to introduce medi- 
cines in aqueous solutions into the subcutaneous areolar tissues, 
from which a solution is quickly absorbed. A special syringe, car- 



44 GENERAL THERAPEUTICS. 

rying a sharp hollow needle, is used for this purpose. Hypo- 
dermic injections were introduced by Alexander Wood in 1853, 
The syringes used at present are modifications of the one de- 
signed by the French surgeon, Pravaz; hence the name Pravaz 
syringe, a term which is still in common use in continental Europe. 
About the body the needle is inserted into the integument by hold- 
ing a fold of the skin between two fingers, but not pinching it. 
The least sensitive parts of the body should be selected — the back, 
the rear part of the thigh, or the arm. Care should be exercised 
not to inject air into the tissues. The injection into the oral tis- 
sues necessitates detailed description. (See Technique of the In- 
jection.) The hypodermic method possesses great advantages, as 
precise doses of powerful alkaloids can be quickly administered, 
avoiding possible reactions between the drugs and the contents of 
the stomach. The solutions should always be made fresh from 
sterile water, or, still better, from an isotonic salt solution, which 
materially lessens the pain of the hypodermic injection. The 
skin at the place of injection should be cleansed, and aseptic care 
must be taken to avoid infection, as otherwise abscesses are sure 
to follow. The quantity of solution injected is usually limited to 
15 to 30 drops (1 to 2 Cc), although antitoxic sera frequently 
require larger doses. The absorption takes place very rapidly 
along the lymph canals and into the capillaries, and usually a 
typical drug effect is obtained within a few minutes. The same dose 
of medicine administered in solution by the mouth would require 
half an hour or more before the action could be demonstrated. 
Intramuscular injection is sometimes resorted to, and is usually 
restricted to oily or aqueous solutions of irritant drugs. Intra- 
venus injection (transfusion, hypodermoclysis) is occasionally 
practiced, and it consists in injecting directly into a vein. It is 
most frequently employed for the injection of a large quantity of 
physiologic saline solution for the purpose of restoring the quantity 
of blood after severe hemorrhage, or securing excretions in certain 
intoxications — as in uremia, diabetic coma, etc. The endermic 
method is employed to obtain a rapid action of a remedy, and con- 
sists in raising a blister by stronger water of ammonia or by a 
blistering plaster, and, after cutting away the raised epidermis, 



METHODS OF ADMINISTERING MEDICINES. 45 

sprinkling the drug on the exposed surface. This method is, 
however, only of historical interest at present. The enepidermic 
method endeavors to bring about absorption of drugs through the 
skin by simple contact without friction, and chloroform and solu- 
tions of drugs in oleic acid (oleates) are used for such purposes. 
In the epidermic method, or inunction, the remedy is usually em- 
ployed in the form of an ointment, oil, etc., with friction to pro- 
mote the passage through the epidermis. 

Inhalations are employed in the administration of remedial 
substances into the upper air passages or into the lung by active 
inspiration. Substances in vapor form, or in very fine division 
in the form of fumes or clouds, are inhaled, and thus brought into 
close contact with the diseased surfaces, or, by ready absorption, 
they act on the general system — as in general anesthesia. In 
the latter case special apparatus (masks, etc.) are necessary, while 
a spray (atomizer) conveys the medicine into the posterior part 
of the mouth. 

Inoculation is employed for the purpose of introducing medici- 
nal agents through the scraped or punctured skin (vaccination) . 

Apparently there is still some misunderstanding as to whether 
a dentist has the legal right to administer drugs intended for sys- 
temic treatment. While there is no specific legislation on this 
particular question, the courts in the United States and Great 
Britain have uniformly held that the registered dental practitioner 
has the right to employ such therapeutic measures, including 
drugs, as may be needed for the relief of suffering, or to produce 
curative results, in dental disorders. The qualified dentist is fully 
entitled to prescribe drugs for local or general disorders which 
bear a direct relationship to the practice of dental surgery, includ- 
ing the administration of anesthetics. 1 Dentistry, in the broadest 
sense of the term, is "a special department of the science and art 
of healing, embracing a knowledge of the structures, physiology, 
and pathology, and the therapeutic, surgical, and mechanical 

1 There is now (1909) a bill before the Parliament of Great Britain entitled "General Anes- 
thetics Act, 19C8," which provides that no "person other than a legally qualified medical prac- 
titioner shall be permitted to administer, or cause to be administered, to any other person, by 
inhalation or otherwise, any drug or substance, whether solid, liquid, vaporous, or gaseous, and 
whether pure or mixed with any other drug or substance, with the object of producing a state 
of unconsciousness during any medical or surgical operation, act, or procedure, or during 
childbirth." 



46 GENERAL THERAPEUTICS. 

treatment of the mouth and its contained organs ; also a knowledge 
of the materials used and their manipulation in the restoration 
of the dental and oral structures." (Kirk.) 

At present dentistry is regarded as a distinct profession. It is 
closely related to, but not identical with, medicine and surgery. 
A dentist is, therefore, not to be classified as a specialist of a 
branch of medicine. To be a specialist means 'to be "one who 
has a special knowledge of some particular subject; thus, ophthal- 
mologist, neurologist, or gynecologist is a specialist of medicine." 
(Century Encyclopedia.) In other words, to be a medical spe- 
cialist means to be primarily the possessor of that knowledge, ac- 
cording to the conception of the law, which entitles one to practice 
medicine in all its branches by virtue of the state medical license. 
Some courts have held that dentistry is a specialty of medicine. 
In the opinion of the Supreme Court of Minnesota, in the case of 
State vs. Taylor, 1 a person holding a state medical license can 
not practice dentistry under the statutes of that state. The follow- 
ing is a synopsis of the decision in that case : 

"For reason of public policy, with which the Court has no particular 
concern, the Legislature adopted the policy of dividing the field of medicine 
and surgery, and making a separate profession of a part thereof. It was 
thought that men who engaged in the treatment of diseases of the dental 
organs should receive special preparation and be specially licensed to prac- 
tice that particular branch or department of medicine and surgery. A 
State Board of Dental Examiners was created and authorized to determine 
who should be licensed and entitled to practice dentistry in the state. A 
department of Dental Surgery was also established at the University (of 
Minnesota) , with a course of study, the satisfactory completion of which would 
entitle the student to a special degree of Dental Surgery. An examination of 
this course shows that it includes a considerable part of the work required in 
the medical school, but it also includes studies which relate particularly to 
diseases of the dental organs and others designed to insure efficiency in the 
mechanical work connected with the treatment. From an examination of 
the statutes of other states relating to the practice of dentistry, the Court 
learns that many contain express exceptions in favor of physicians and 
surgeons. Probably the most of them permit physicians to extract teeth, 
or perform such other comparatively simple work. In the absence of any 
such exceptions, it must conclude that the Legislature intended to restrict 
the scope of the practice of the physician and surgeon, and require him, if 
he desires to practice dentistry, to obtain a license from the State Board of 
Dental Examiners in addition to his other certificate." 



1 Journal of A. M. A., 1909, p. 122. 



PRESCRIPTION WRITING. 47 

PRESCRIPTION WRITING. 

A prescription, from the Latin prae (before) and scribo (I 
write), may be denned as a written order for medicines sent by a 
physician to a pharmacist. Prescriptions are termed simple if 
containing but one ingredient, and compound if containing more 
than one. The writing of a prescription involves a series of diffi- 
cult problems, and, when first attempted, imposes a great task 
on the student. To become an expert prescription writer is largely 
a matter of practice. There are, however, a few simple, funda- 
mental rules which, when once fixed in the mind, will materially 
assist in overcoming these difficulties. 

"In writing prescriptions, the Latin is preferred: (1) It is the 
language of science, and is understood to a greater or less extent 
throughout the civilized world; in addition, it is a dead language, 
and therefore not subject to the changes that are common to all 
living forms of speech. (2) The Latin names for medicines are 
distinctive, and very nearly the same in all countries. (3) It is 
frequently necessary, and always advisable, to withhold from the 
patient the names and properties of the medicinal agents adminis- 
tered/' (Remington.) 

"What an insignificant piece of paper a prescription is; yet it 
may be the cause of much unhappiness of at least three persons — 
the patient, the pharmacist, and the physician." ( Robert.) 

The pharmacist who dispenses the medicine should invariably 
retain the original prescription for future reference and as a record 
for a limited period — say, five years. This is for his own protec- 
tion as well as for that of the prescriber and the patient. The 
medicine prescribed should be supplied not more than once on 
the same prescription in the following instances : 

(a) If ordered by the prescriber "not to be repeated," or 
marked (( ne repetatur." 

(b) If it contains medicinal substances commonly called nar- 
cotic or habit forming drugs. 

(c) If asked for by a person known to be the original holder. 
A modern prescription may be divided into the following parts : 
1. The Name of the Patient. — Although frequently omitted, 



48 GENERAL THERAPEUTICS. 

the name of the patient should always be written at the top of the 
prescription in order to avoid the possibility of serious mistakes. It 
should be written also on the label by the compounder. 

2. The Superscription, or Heading. — The symbol 3J* 1 rep- 
resenting the Latin word recipe (take), is placed at the head of all 
Latin prescriptions. 

3. The Inscription, or the Names and Quantities of the 
Ingredients. — This part of the prescription is the most impor- 
tant, and requires the greatest care. The official names of the 
drugs should always be used. The inscription 2 often consists of a 
number of ingredients, and may be subdivided into: (a) The 
basis, or chief active ingredient; (b) the adjuvant, or aid to the 
basis — that is, to assist its action; (c) the corrective, which is in- 
tended to qualify the action of the basis and adjuvant; (d) the 
vehicle, or diluent, which serves to hold together, to dilute, or to 
give the whole the proper consistency, form, and color. 

Each ingredient and its quantity should occupy only one line, 
and the ingredients should follow each other in the order of their 
importance. 

Many prescriptions contain but one or two ingredients — there 
being no special use for a corrective, vehicle, or diluent — the tend- 
ency of modern therapeutics being against polypharmacy and in 
the direction of simple and concentrated remedies, or those having 
positive effects. There are, however, many advantages to be 
derived from the combination of ingredients even when they have 
similar medicinal action. The method generally followed by 
physicians to ascertain the quantity of each ingredient is, first, to 
write the names of the ingredients in the proper order, each on a 
separate line, without affixing the quantities; second, having de- 
cided upon the total number of doses that are to be given, to mul- 
tiply the correct quantity of a single dose of each ingredient by the 
total number of doses to be given, and thus obtain the required 



1 It was customary with the Roman physicians to prepare a prescription with a pious invoca- 
tion to Jupiter, or some other deity, usually expressed by the astronomic sign %, the symbol of 
the planet Jupiter. The diagonal stroke across a part of the letter R (R) heading modern 
prescriptions is a relic of this usage of the planetary sign. 

2 This classic form of the inscription was originally evolved by Dr. Paris from a careful 
analysis of the older and more complex types of prescriptions, and consisted of basis, adjuvans, 
corrigens, et excipiens. 



PRESCRIPTION WRITING. 49 

quantity of each ingredient. Great care should be used in abbrevi- 
ating, so that each abbreviation is distinctive, and not liable to be 
mistaken for an article not intended by the writer. For example, 
acid, hydroc. may mean acid, hydrochloric or acid, hydrocyanic; 
hydr. chlor. may mean calomel, corrosive sublimate, or chloral 
hydrate. The cabalistic characters in present use designating the 
quantities in a Latin prescription must be plainly written if serious 
errors are to be avoided. 

4. The Subscription, or the Directions to the Com- 
pounder. — Usually no specific directions are given to the com- 
pounder. A single letter, or two or three letters, will serve as a 
subscription — as M., misce (mix) ; D. S., detur signetur (give and 
mark) ; M. D. S., misce, da, signa, or misce, detur, signetur (mix, 
give, and mark) ; S., solve (dissolve) ; F., fiat (make). 

5. The Directions for the Patient. — S. or Sig., indicating 
signatura, precedes the directions for the patient, which should 
always be written in full and in plain English. Not properly 
specifying the directions — -for example, writing u as directed," or 
"use as directed," accompanied by verbal instructions — is a careless 
habit, and has led to serious consequences. 

6. The Name or Initials of the Physician and Date. — The 
name of the prescriber should always appear on the prescription, 
either in print or plainly written. 

The following is an example of how a prescription should be 
written : 

Name of Patient- 
Superscription (Heading) — 

f Basis 

Inscription (Ingredients) — < * - . 

I trwv cot iiii 



Corrective- 
Vehicle— 



Subscription (Direction) 



For Mr. Charles Jones. 


$ 






Acid. 


benzoic. 


5J 


Tinct. 


kramer. 


flfriv 


01. menth. pip. 


gtt. XX 


Alcohol 


q. s. ad fl^ iv 


M. 






Sig. 


: Half a 


teaspoonful in a 


glass 


of water 


as a mouth wash. 




James 


King, D. D. S. 


Jan 


16, 1909. 





The present mode of having prescription blanks printed with 
the full name and address of the prescriber is greatly to be 
encouraged. 



50 GENERAL THERAPEUTICS. 

If simple solutions are used, prescriptions may be written so as 
to express the strength of the solution in percents, as follows : 

I£ Solutio cocainae hydrochloridi 4% fig iv (120 Cc.) 

In preparing a percentage solution, it should be remembered 
that the specific amount of the soluble matter is dissolved in 100 

Telephone— Main 5333. Hours— 9 to 3. 

JAMES KING, D. D. S. 

603 Century Building, 
St. Louis, Mo. 

For /%\/, CsLaAjjJ jLn^t^ 

Olc^r£ a..*, ad 




W, /Id } {</#?> 





Figure 4. 
Fac-Simile of a Correctly Written Prescription. 

parts of the solution — as, a 4-percent aqueous solution of cocain 
hydrochlorid is composed of" 4 parts of cocain hydrochlorid and 
96 parts of distilled water. Percentage solutions are best pre- 
pared by weighing both the soluble matter and the liquid. The 
quantity of soluble substance and solvent necessary to make a 
specified quantity of any particular percentage solution may be 



PRESCRIPTION' WRITING. 51 

readily ascertained by the following rule : Multiply the quantity 
of solution desired, in grams or grains, by the number expressing 
the percentage, divide the product by 100, and the quotient will 
indicate the quantity of soluble substance necessary : subtract this 
from the total quantity of solution desired, and the remainder will 
indicate the necessary quantity of solvent. 

Metric Prescription Writing. 

Metric prescription writing is universally employed in all coun- 
tries except in those inhabited by English-speaking communities. 
In the United States and England it is at present practiced only 
to a limited extent, although strenuous efforts are made to popular- 
ize this method by teaching it in the various medical and dental 
schools. In continental Europe all ingredients entering into a 
prescription are weighed, no measures of capacity, except drops. 
being employed. The unit of weight is the gram. In the United 
States two methods of expressing the quantities are in vogue — one 
i- the volumetric method, which, following the usual American 
practice, measures the liquids, and the other is the European or 
gravimetric method. The former is preferred by many. The unit 
of measure is the cubic centimeter (abbreviated Oe.), which is the 
equivalent of one gram of distilled water at 4° C. The gravimetric 
method — weighing of all ingredients — is by far the better method, 
as under all conditions (temperature, specific gravity, etc.) it will 
furnish the exact quantity as specified in the prescription. A few 
examples will illustrate the two methods : 

VOLUMETRIC. GRAVIMETRIC. 

Gm. vel Cc. 

Acid, benzoic 4 Acid, benzoic 4.0 

Tinct. kramer 15 Tinct. kramer 15.0 

01. menth. pip 15 01. menth. pip 1.5 

Alcohol q. s. ad 120 Alcohol q. s. ad 120.0 

The advantage of writing a prescription in Latin has been 
referred to on page 47. To correctly construct the terminology 
of a prescription requires a fundamental knowledge of Latin 
grammar. In writing the heading of the prescription. R — recipe 
(take) [thou] — the imperative singular is employed, as it refers 



52 GENERAL THERAPEUTICS. 

to the quantity to be taken. The latter is, in consequence, placed 
in the accusative: 

J$l drachmam unam. 

Take [thou] one dram. 

The quantity expressed refers to the name of the drug, and the 

latter, according to rule, is placed in the genitive : 

I£ Magnesii sulphatis drachmam unam.' 

Take [thou] one dram of sulphate of magnesia. 

When. "ad" follows the vehicle, the latter is placed in the 
accusative : 

I£ Magnesii sulphatis drachmam unam. 

Aquam ad fluid unciam unam. 

Take [thou] one dram of sulphate of magnesia [and] enough 
water to make a fluidounce. 

Owing to common practice, the last syllable of the Latin words, 
which varies with the case, is usually omitted, but, to correctly 
interpret the Latin words, the case endings must be remembered. 



Latin Genitive Case Endings. 

NOMINATIVE. GENITIVE. EXCEPTIONS. . 

-a -ae. . . . Cataplasma, enema, physostigma, aspidosperma, 

and gargarisma end in -atis; folia (pi.), foliorum; 

coca is unchanged, though cocae is used by some, 
-us, -um, -os -i Rhus, rhois; flos, floris; bos, bovis; limon, limonis; 

erigeron, erigerontis; quercus, cornus, fructus, 

spiritus, haustus, and potus are unchanged. 

-as -atis. . . Asclepias, adis; mas, maris; sassafras is unchanged. 

-is -idis. . .Pulvis, -eris; arsenis, phosphis, sulphis, and all 

salts ending in -is take the ending -itis; berberis, 

cannabis, digitalis, hydrastis, and sinapis are 

unchanged, 
-o -onis . .Mucilago, ustilago, and solidago end in -inis; con- 

durango, kino, sago, and matico are unchanged. 

-1 -lis. . . .Fel, fellis; mel, mellis; sumbul, sumbuli. 

-en -inis . . . Azedarach, buchu, catechu, curare, jaborandi, and 

amyl are unchanged, though amylis is sometimes 

used. 

-ps -pis 

-rs -rtis. . . 

-r -ris. . . . 

-x -cis 



PRESCRIPTION WRITING. 



53 



Terms Used in Prescription Writing. 

The more important abbreviations and Latin terms used in 
writing prescriptions : 



aa, ana of each. 

ad .to, up to. 

adde add to it. 

ad lib., ad libitum. at pleasure. 

aqua water. 

aqua communis. . .common water. 

aqua bulliens boiling water. 

aqua f ervens hot water. 

aqua f on talis spring water. 

aqua pluvialis rain water. 

balneum bath. 

bis twice. 

b. i. d., bis in die. twice daily. 

bolus large pill. 

butyrum butter. 

cataplasma poultice. 

caute cautiously. 

charta paper. 

cochleare a spoonful. 

cochleare mag- 
num a tablespoonf ul. 

cochleare parvum . a teaspoonful. 

coctio boiling. 

cola strain. 

collutorium a mouth wash. 

collyrium an eye wash. 

contusus bruises. 

cortex the bark. 

cujus of which, of any. 

cum with. 

da, detur give. 

decanta pour off. 

decern ten, the tenth. 

d. t. d. , dentur tales 

doses let such doses be 

given. 

dexter, dextra .... the right. 

dilue dilute. 

d. in p. seq. , divide 
in partes aequa- 

les let it be divided in 

equal parts. 

dosis a dose. 



ejusdem of the same. 

enemata clyster. 

et and. 

extractum an extract. 

f., fiat, fiant let it be made. 

farina flour. 

f ebris fever. 

filtra filter. 

fluidus liquid. 

gargarisma a gargle. 

haustus a draught. 

herba an herb. 

hirudo a leech. 

hora an hour. 

idem the same. 

infusum an infusion. 

injectio an injection. 

inter between. 

lac milk. 

linimentum a liniment. 

liquor a solution. 

massa a mass. 

misce mix. 

non not. 

nox, noctis night. 

omni hora every hour. 

ovum an egg. 

pilula a pill. 

potus a drink. 

pro for. 

p. r. n. , p r o re 

nata occasionally. 

pulvis a powder. 

q. s. , quantum , 

satis as much as is suf- 
ficient. 

radix .a root. 

recens fresh. 

repetatur let it be repeated. 

scatula a box. 

s. a., secundum 

artem according to art. 

semel once. 



54 



GENERAL THERAPEUTICS. 



signa mark. 

sine without. 

solve dissolve. 

talis such, like this. 

t. i. d., ter in die. three times daily. 



tere rub. 

tinctura a tincture. 

trochisci. lozenges. 

vas vitreum a glass vessel. 

vitellus ovi yolk of an egg. 



Reference Abbreviations. 



U. S. P.. United States Pharmacopeia. 
B. P British Pharmacopeia. 



P. G German Pharmacopeia. 

N. F National Formulary. 



Signs and Numerals Used in Prescription Writing. 

J$c recipe take. 

lb libra a pound. 

5 uncia an ounce. 

3 drachma a dram. 

9 scrupulus a scruple. 

gr granum a grain. 

C. congius a gallon. 

octarius a pint. 

fl 5 fluiduncia a fluidounce. 

A3 fluidrachma a fluidram. 

TTL- minim a drop. 

gtt gutta a drop. 

ss semis half. 

The Use of Latin Numerals. 

All Latin numbers are expressed by one, or a combination of 
two or more, of the following letters: I, V, X, L, C, D, and M. 
I means 1; V, 5; X, 10; L, 50; C, 100; D, 500; and M, 1000. 
These should be written together as capital letters, but in prescrip- 
tions we find them usually written as small letters, or in print as 
'lower case" letters, and it is customary to write a single "i," or 
the final "i" when several numeral letters are used together, as a 
small "j." The letters are combined thus: 



I.... 

II... 

III.. 

IV.. 

V... 

VI... 

VII. . 

VIII. 

IX. . 

X... 

XL. 



1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 



XX. 
XL. 
L... 
LX. 
XC. 
C... 
CC. 
D.. 
DC. 
M.. 



20 

40 

50 

60 

90 

100 

200 

500 

600 

1000 

MCMVIII 1908 



PRESCRIPTION WRITING. 55 

The Dose. 

For the first time in its history, the Eighth Decennial Revision 
(1905) of the Pharmacopeia of the United States has admitted 
average approximate doses of medicines for adults to be used in- 
ternally or hypodermically. These doses are not, however, obliga- 
tory on the physician, and may be increased or reduced according 
to circumstances. It is a matter of clinical experience with each 
practitioner to safely adjust the dose for the case on hand. In 
using a powerful remedy, it is best to start with a small dose' and 
increase cautiously. Various circumstances modifying the dose 
demand attention, as follows: 

Age. — Children and the old require smaller doses than the 
adult. The following rule of Dr. Young is now almost universally 
adopted: For children under twelve years the dose of most medi- 
cines must be reduced in the proportion of the age to the age 
increased by twelve. For example, at two years the dose is 

reduced to L /~ ( 9 4.1 9 ~ 2 ^ 14> or 1 ^ 7 ) ; anc ^ at ^ our y ears ^ * s re " 

duced to 1 /±[ a 1 -19 — V 1 ^ or V*.). At twenty-one the full dose 
may be given. 

Sex, Temperament, and Idiosyncrasy. — Females and persons 
of sanguine temperament require somewhat smaller doses than 
males and the phlegmatic. Idiosyncrasy, the peculiar suscepti- 
bility of some individuals to the actions of peculiar medicines — as 
opium, mercury, quinin, iodids, etc. — require a modification of 
the dose accordingly. Some drugs — as calomel, chloral hydrate, 
and arsenic — are peculiarly well borne by children, being taken 
by them in relatively large doses. On the other hand, children 
are peculiarly susceptible to the influence of opium. Again, many 
drugs — as ipecacuanha, tartar emetic, alcohol, etc. — have different 
action in different doses. 

Habit. — The use of one drug, in order to maintain a certain 
effect, must be regularly increased. This is specifically true in nar- 
cotics. It is, therefore, good practice to vary the medicine and 
employ successively several with the same general powers. 

Frequency and Time. — The effect derived from the medicines 



56 - GENERAL THERAPEUTICS. 

is largely the guiding post of frequency and time at which they 
should be taken. Purgatives are usually taken in a single dose in 
the morning; emetics are to be taken once, and repeated only in 
case vomiting is not induced; drugs which induce sleep are natur- 
ally given at bedtime; alkaline stomachics, before meals; tonics, 
three times a day continuously. The interval between the doses 
should be calculated and the second dose administered before the 
effect produced by the first has passed off. 

Dukation. — Drugs may be given at longer or shorter intervals, 
depending on many circumstances. Custom, habit, and toleration 
play an important part. Many drugs, by their slow excretion from 
the body, may become accumulated and thus may produce their 
effects in a marked degree — as strychnin. On the other hand, 
some drugs lose their effect when given for a length of time, a tol- 
eration being established — as opium. If a patient becomes de- 
pendent on a drug, a habit for that drug may be established — as 
cocain. 

Estimation of Quantities. 

The estimation of the quantity of each ingredient entering into 
a compound prescription is usually ascertained after the various 
drugs have been written in their order, beginning with the solids. 
The amount of the whole mixture, powder, etc., is written after the 
last ingredient, wmich is usually the diluent, and the quantity of 
each drug is ascertained by multiplying the single dose by the 
number of doses represented in the whole prescription. The fol- 
lowing may serve as a simple example : 

It is desired to. write a prescription for a four-ounce mixture, 
with a dram (a teaspoon ful) at a dose, each dose to represent two 
grains of quinin sulphate, one-eighth of a grain of codein phos- 
phate, half a dram of syrup of licorice, and water enough to make 
a teaspoonful. As 4 ounces are 32 drams, the prescription will 
read as follows : 



Quinin sulphate 


2 gr. x 32 = 3 J 


Codein phosphate 


Vs gr. x 32 =. gr. iv 


Syrup of licorice 


H dram x 32 = fl§ ij 


Water 
M. 
Sig. : Teaspoonful 


enough to make fl^iv 


every two hours. 



PRESCRIPTION WRITING. 57 

To assist the compounder in filling the prescription, it is cus- 
tomary to express the multiples of grains, when they closely 
approximate half a dram or more, in round numbers. In the 
above case, to be exact, 64 grains of quinin sulphate are called 
for, but, following the rule, one dram is written. 

The bottles used in the United States and England have a 
capacity of one, two, and four fluidrams, and one, two, three, four, 
six, eight, twelve, sixteen, and thirty-two fluidounces, or their 
relative metric equivalents expressed in cubic centimeters (Cc). 
It is good practice, in prescription writing, to conform the quan- 
tity of the mixture to the above sizes of bottles. The quantity of 
medicine ordered should last from two to three days, except in the 
treatment of chronic diseases. Mouth washes may be ordered in 
four to sixteen-ounce quantities. In measuring out the medicine 
to the patient, a graduated medicine glass is far preferable to the 
domestic measures, as the latter vary considerably. Very recently 
M. I. Wilbert, formerly apothecary to the German Hospital, Phila- 
delphia, ascertained that the domestic teaspoonful varies very 
greatly in size, and he therefore suggests that a teaspoonful should 
be represented by l 1 / i drams, or 5 cubic centimeters. Drops should 
always be measured with a medicine dropper or dispensed in a 
special drop bottle. 

Dr. Seaman recommended to the Committee on Revision of the 
United States Pharmacopeia the following method of accurate 
drop measure: "An official medicine dropper has its delivery end 
three millimeters in external diameter, and adapted to deliver 20 
drops of distilled water to a gram at 15° C." 

Powders are usually prescribed to weigh from three to ten grains ; 
if they contain nauseating tasting drugs, they should be dispensed 
in capsules or wafers. Pills usually weigh from one to three grains, 
and. those that weigh less than a grain are known as granules. 
Salves are prescribed in one-half to two-ounce quantities. Oils, 
balsams, oleoresins, and similar liquids, if prepared in drop doses, 
are best dispensed in soft or hard gelatin capsules. Solid and 
semi-solid dentifrices — such as powders, pastes, and soaps — are 
usually dispensed in specially prepared containers, while bottles 
containing mouth washes are often provided with sprinkler tops. 



58 GENERAL THERAPEUTICS. 

INCOMPATIBILITIES. 

Incompatibilities may be denned as conditions produced by 
bringing substances together which result in chemic decomposi- 
tion, pharmaceutic dissociation, or therapeutic opposition. (Rem- 
ington.) 

In writing a prescription which contains more 'than one drug, 
one or all of the above possibilities may be the result of the mix- 
ture, unless the prescriber exercises extreme care in considering 
the physical, chemic, and physiologic properties of the ingredi- 
ents entering into the compound. 

1. Chemic Incompatibility. — It may result in (a) explosion 
in mixing chlorates or permanganates with readily oxidizable 
substances (all organic substances — sulphur, etc.) ; (b) precipita- 
tion — in general, inorganic bases or their salts precipitate in- 
organic acids, and salts of metals precipitate organic substances; 
(c) production of a substance with undesirable properties — iodids, 
bromids, iodates, bromates, and chlorates with strong mineral 
acids or strong oxidizing agents. 

2. Pharmaceutic Incompatibility. — (a) Alcoho I should not 
be added to solutions of acacia, gelatin, and proteins, or to emul- 
sions and strong salt solutions ; (b) water should not be added to 
alcoholic liquids in general (tinctures, spirits, fluid extracts) ; 
(c) certain chemicals, like camphor or antipyrin, when mixed 
with phenol, thymol, cocain, salol, resorcinol, etc., produce oily 
liquids; (d) cocain and borax form an insoluble borate of cocain. 

3. Therapeutic Incompatibility. — As a rule, a drug is 
incompatible with its antidotes — as pilocarpin and atropin. 

As it is impossible to consider in detail all the incompatibilities, 
only a few of the more important ones will be enumerated : 

An acid should not be combined with an alkali. 

Most of the acids precipitate albumin. 

Arsenic trioxid is precipitated by salts of iron and magnesia, 
which are its official antidote. 

Phenol forms a phenolsulphonate when added to a soluble 
sulphate. 

Salicylic acid is incompatible with salts of iron. 



INCOMPATIBILITIES. 59 

Alkalies should not be combined with alkaloids. 

Alkaloids and metallic salts are incompatible with tannic acid 
or substances containing tannin, and with alkalies or their salts. 

Fluid extracts are precipitated by water or aqueous liquids. 

Iodin or iodids should not be given with alkalies. 

Oils, volatile and fixed, resins, oleoresins, resinoids, and balsams 
are precipitated by water. 

Sugar forms an explosive with sulphuric acid. 

Corrosive sublimate, silver nitrate, potassium iodid, and the 
salts of lead should preferably be prescribed alone. Corrosive 
sublimate is frequently prescribed in combination with potassium 
iodid, when a precipitate is formed which is readily dissolved. 
Silver nitrate and lead acetate are frequently prescribed with the 
extracts of opium and hyoscyamus. Substances containing loosely 
combined oxygen — as chromic acid, concentrated nitric acid, per- 
manganates, chlorates, etc. — should not be combined with easily 
oxidizable substances (as all organic substances — tannic acid, sul- 
phur, sulphids, sulphites, iodin, iodids, phosphorus, phosphites, 
and reduced iron — which form highly explosive compounds) . 

Vegetable astringents containing tannic acid should not be 
mixed with iron, as they form a tannate of iron (ink) . 

Alcohol and alcoholic liquids are incompatible with mucilages. 

Examples of Incompatibility. 

$. Cocainas hydrochlor. gr. v 

Sod. borat. gr. x 

Aq. ad fig j 

M. 

Sig. : Use as a paint. 

An insoluble cocain borate is formed. 

^ Sod. borat. 5 vj 

Mucilag. acac. AS j 

Aq. menth. pip. ad flg viij 

M. 

Sig. : Tablespoonful three times daily. 

The borax will be precipitated by the mucilage in translucent 
flocculent masses. 



60 GENERAL THERAPEUTICS. 

Tjc Pot. permangan. 5 j 

Aq. hydrogen, dioxid. fl£ ij 

Aq. ad flg viij 

M. 

Sig. : Antiseptic solution. 

The potassium permanganate is decomposed by the solution of 
hydrogen dioxid. 

J$l Pot. permangan. 3 j 

Liq. formaldehyd A3 iij 

Aq. ad flg viij 

M. 

Sig. : For disinfecting purposes. 

A violent reaction between the potassium permanganate and 
the solution of formaldehyd results, setting free vapors of formal- 
dehyd. 

ty Phenol. 

Camphorse aa 3 ij 

M. f. plv. No. j. 
Sig. : Dissolve in a quart of water. 

Phenol and camphor liquefy when triturated together, and very 
little of the camphor will dissolve in the water. 

fy Magnes. oxid. 3 U 

Aq. menth. pip. flg iij 

M. Shake the bottle. 
Sig. : Tablespoonful three times daily. 

The magnesia settles to a solid mass, which can not be readily 

disintegrated by shaking. 

$. Liq. plumbi subacet. flg iv 

Tinct. opii flg j 

Aq. ad flg xvj 

M. 
Sig. : Use externally. 

This is the much used lead water and laudanum. The alkaloids 

of opium are precipitated by the solution of lead subacetate, and, 

besides, opium does not exert any local action. 



$. Sod. borat. 


gr. iij 


- Zinc sulphat. 


gr. iv 


Aq. destill. 


A3 3 


M. 




Sig. : Drop into the eye. 




n insoluble zinc borate is formed. 





WEIGHTS AND MEASURES. 61 

$. Argenti nitrat. 3 ij 

Aq. rosae AS J 

M. 

Sig. : Concentrated silver nitrate solution for dental pur- 
poses. 

Most of the silver nitrate is precipitated as a black powder by the 

oil of rose and the impurities of the rose water. Only distilled 

water should be used in making silver nitrate solutions. 

Ifc Pot. chlorat. 5 j 

Acid, tannic. 5 ss 

Amyl. ad g ij 

M. f. plv. 

Sig. : Use as a dusting powder. 

An explosive compound results. 

^ Phenol. 

Thymol. aa 3 ij 

M. f. plv. No. ij. 

Sig. : Dissolve in one ounce of alcohol, and use for the 
treatment of putrescent root canals. 

Phenol and thymol liquefy when triturated together. 

$. Chloral hydrat. 

Sulphonal. aa gr. xv 

M. f. plv. No. vj. 
Sig. : One powder every other evening. 

When triturated together the two drugs form a soft, pasty mass. 



WEIGHTS AND MEASURES. 

The system of weights and measures as used in the United 
States was standardized in 1836, when the then Secretary of the 
Treasury was authorized by Congress to furnish each state of the 
Union with a complete set of revised standards for weights, liquid 
measures, and measures of length. These various methods of 
weights and measures are quite confusing when an examination of 
their comparative units is made — that is, it is perplexing to find 
that a pound is not a pint, an ounce does not equal a fluidbunce, 
and a drop is neither a grain nor a minim. 

The United States National Prototype Standards, from which 
all weights and measures now used in this country are derived, 



62 



GENERAL THERAPEUTICS. 



are the meter and the kilogram, and they are preserved in the 
custody of the National Bureau of Standards at Washington. The 
United States meter and kilogram are identical with the interna- 
tional standards of the same capacity. 

The United States standards of weights and measures are: 



The apothecaries' or troy ounce 
The commercial or avoirdupois ounce 
The apothecaries' fluidounce (identical 
with the fluidounce of the liquid gallon) = 480 minims. 



= 480 grains. 
= 437.5 grains. 



The weights and measures used in the British Pharmacopeia 
are the Imperial weights and measures, legal for commercial pur- 
poses in the British Empire. The English apothecaries' weights 
are the same as those used in the United States. 

Apothecaries' Weight. 



Pound. 


Troy ounces. 


Drams. Scruples. 


Troy grains. 


lb 1 • 


= 12 


= 96 = 


288 


= 5760 




51 


= 8 = 


24 


= 480 






51 


3 
31 


= 60 
= gr. 20 






Troy Weight. 






Pound. 


Troy ounces. Pennyweights 




Troy grains. 


lb 1 


= 12 


= 240 




= 5760 




* 1 


= 20 
dwt. 1 




= 480 
= gr. 24 




Avoirdupois Weight. 






Pound. 


Ounces. 


Drams. 




Troy grains. 


lb l 


= 16 


= 256 


= 


7000. 




oz. 1 


= 16 


= 


437.5 






dr. 1 


= 


gr. 27.34375 



Relative Value of Troy and Avoirdupois Pounds. 



1 troy pound 

1 avoirdupois pound 



0.822857 avoirdupois pound. 
1.215277 troy pounds. 



Apothecaries' or Wine Measure (United States). 

Gallon. Pints. Fluidounces. Fluidrams. Minims. Cubic inches. 

Cong. 1 = 8 = 128 = 1024 = 61440 = 231 

1= 16 = 128 = 7680 = 28.875 

fl^ 1 = 8 = 480 = 1.8047 

A3 1 = TTL 60 = .2256 



WEIGHTS AND MEASURES. 



63 



1 gallon 
1 quart 



Liquid Measure. 



4 quarts. 
2 pints. 



1 pint 
1 gill 



4 gills. 

4 fluidounces. 



Imperial Measure (British Pharmacopeia). 



Gallon. 




Pints. 




Fluidounces. 




Fluidrams. 




Minims. 


1 


= 


8 


= 


160 


== 


1280 


= 


76800 






1 


= 


20 


= 


160 


= 


9600 










1 


— . 


8 
1 


= 


480 
60 



The Metric System. 1 

The metric or decimal system of weights and measures origi- 
nated with Prince de Talleyrand, bishop of Autun, in 1790. Its 
almost universal adoption by civilized nations, its legality (though 
not compulsion) in England and the United States, and its adop- 
tion by the United States Pharmacopeia of 1890 demand that it 
should be understood by the progressive practicing physician. Ex- 
cept in the English-speaking world, it is the only system of weights 
and measures used for governmental, statistical, and scientific pur- 
poses. It is based upon the decimal system — that is, the denomina- 
tions increase by tens and decrease by tenths. The starting point 
is the unit of linear measures, the meter, which represents one- 
ten-millionth of the polar quadrant of the eartli— that is, the dis- 
tance from the equator to the poles — and is equivalent to 39.37 
English inches. The gram (Gm.) is the unit of weight; the liter, 
of capacity (although the cubic centimeter is oftener preferably 
used) ; the are, of surface measure. The denominations repre- 
senting the subdivisions of any unit are expressed by prefixing 
the Latin numerals deci, centi, and milli to the unit — meaning re- 
spectively one-tenth, one-hundredth, and one-thousandth; the 
multiples are expressed by prefixing the Greek numerals deka, 
hecto, kilo, and myria — meaning ten, hundred, thousand, and ten 
thousand. 

The gram is derived as follows : The meter is divided into one 



1 The metric system was legalized in Great Britain in 1864, and in the United States by act of 
Congress in 1866. 



64 



GENERAL THERAPEUTICS. 



hundred equal parts, called centimeters. On one centimeter as 
a base a cube is erected, having for its three dimensions one centi- 
meter (Cm.) each. The contents of this cube will be one cubic 
centimeter (Cc), measuring one milliliter. This quantity of dis- 
tilled water at its maximum density (39.2° F., 4° C.) and 30 
inches barometric pressure weighs one gram, or 15.432 grains. 

The liter is derived as follows: The meter is divided into ten 
equal parts, called decimeters. On one decimeter as a base a 
cube is erected, having for its three dimensions one decimeter 
(dm.) each. The contents of this cube will be one cubic decimeter 
(dm. 3 ), the capacity of which is one liter, equivalent to 1,000 
cubic centimeters, or 33.81 fluidounces, or 2.113 pints. One liter 
of distilled water at 4° C. and 30 inches barometric pressure weighs 
1,000 grams, or 1 kilogram, or 2.2 pounds avoirdupois, or 15,432 
grains. 

Metric Weights and Measures. 



The meter, or unit of length, 
The liter, or unit of capacity, 
The gram, or unit of weight, 



39.37043 inches. 

33.814 fluidounces (U. S.)\ 

15.432348 troy grains. 



Metric Measures of Length. 



English inches. 

Millimeter (mm.) = .03937 

Centimeter (cm.) = .39370 



Decimeter (dm.) 
Meter (m.) 



Kilometer = 39370.43 English inches. 



English inches 

3.93704 
39.37043 



Milliliter (Cc.) 
Centiliter (cl.) 



Metric Measures of Capacity. 



English cubic inches. 

= .06102 

= .61028 

Hectoliter = 6102. 8 



English cubic inches. 

Deciliter (dl.) = 6.10280 

Liter (L.) = 61.02800 

Inglish cubic inches. 



Milligram (mg.) 
Centigram (eg.) 



Metric Measures of Weight. 



Troy grains. 

.0154 
.1543 



Decigram (dg.) 
Gram (Gm.) 
Kilogram = 15432.34 troy grains. 



Troy grains 

1.5432 
15.4324 



WEIGHTS AND MEASURES. 



65 



Apothecaries' Weight and Metric Equivalents. 



Hqo 


grain 


V64 


<< 


VoO 


< < 


V±0 


<< 


V32 


n 


%0 


<< 


Vl6 


<< 


Vl2 


<« 


VlO 


< < 


% 


< < 


Ve 


< < 


% 


< < 


% 


< < 


tt 


< < 


V2 


< < 


% 


« < 


1 


it 


2 grains 


3 


< < 


4 


< < 


5 


« < 


6 


<« 


8 


<< 


10 


« < 


12 


a 



0.001 

0.0013 

0.0016 

0.002 

0.003 

0.004 

0.005 

0.006 

0.008 

0.011 

0.012 

0.015 

0.022 

0.032 

0.048 

0.065 

0.13 

0.2 

0.26 

0.32 

0.39 

0.52 

0.65 

0.78 



ams. 


15 grains 


= 0.97 grams 




15.4 " 


= 1. 






20 


= 1.3 






24 


= 1.55 ' 






30 


= 1.94 ' 






40 


= 2.6 






45 


= 2.92 < 






50 


= 3.23 ' 






60 " (1 dram) 


= 3.89 ' 






V/o drams 


= 5.58 ' 






1% " 


= 6.81 ' 






2 


= 7.78 ' 






2K " 


= 9.72 ' 






3 


= 11.65 ' 






4 


= 15.55 ' 






5 


= 19.43 ' 






6 


= 23.3 






1 ounce (480 grains 


)= 31.1 






2 ounces 


= 62.2 






3 


= 93.3 






4 


= 124.4 






6 


= 186.6 






8 


= 248.8 






10 


= 311. 






12 


= 373.2 





Apothecaries' Measure and Metric Equivalents. 



1 minim 

2 minims 
3 
4 
5 
6 
7 
8 
9 

10 
15 
20 
25 
30 
40 
45 
50 



0.06 Cc. 


60 minims (1 fluidram) 


= 


3.70 


0.12 


tt 


1% fluidrams 


= 


4.65 


0.18 


a 


m i 




= 


5.60 


0.24 


i i 


1% ( 




= 


6.50 


0.30 


t < 


2 




= 


7.50 


0.36 


a 


3 




= 


11.25 


0.42 


1 i 


4 




= 


15.00 


0.50 


a 


8 


' (lfluidoz.) 


= 


30.00 


0.55 


a 


(more 


exactly) 


= 


29.57 


0.60 


" 


2 fluidou 


mces 


= 


59.15 


0.92 


1 1 


3 




= 


88.72 


1.25 


i t 


4 




= 


118.29 


1.54 


i i 


8 




= 


236.59 


1.90 


i i 


16 


' (1 pint) 


= 


473.18 


2.50 


a 


32 




= 


946.36 


2.80 


a 


128 


' (1 gallon) 


= 


3785.43 


3.10 


i 1 











Cc. 



66 



GENERAL THERAPEUTICS. 



Weight Equivalents. 

To convert grains into grams multiply by 0.065 

To convert grams into grains multiply by 15.5 

To convert drams into grams multiply by 3.9 

To convert ounces (avoirdupois) into grams multiply by 28.4 

To convert pounds (avoirdupois) into grams multiply by 453.6 

Measure Equivalents. 

To convert cubic centimeters into grains multiply by 15.5 

To convert cubic centimeters into drams multiply by 0.26 

To convert cubic centimeters into ounces (avoirdupois) multiply by. 9.03 

To convert pints into cubic centimeters multiply by 473. 

To convert liters into ounces (avoirdupois) multiply by 35.3 

To convert gallons into liters multiply by 3.8 



Approximate Measures. 



A drop equals roughly 1 minim. 
A teaspoonful = 1 fluidram. 

A dessertspoonful === 2 fluidrams. 



A tablespoonful 



= i/ 



fluidounce. 



A wineglassful 
A teacupful 
A tumblerful 
A handful 



= 2 fluidounces. 

= 4 fluidounces. 

= 8 fluidounces. 

= 4 ounces. 



Percentage Solution Table. 

Showing the quantity of drug and water to use for prepar- 
ing aqueous solutions of different strengths. In these calculations 
456 grains have been taken as the weight of one fluidounce of dis- 
tilled water at ordinary temperature. 



Fluidoz. 
water 


Gr. for 
VlOOO 
per- 
cent 
sol'n 


Gr. for 

VoOO 
per- 
cent 

sol'n 


Gr. for 

M 

per- 
cent 
sol'n 


Gr. for 
1 
per- 
cent 
sol'n 


Gr. for 

2 . 

per- 
cent 
sol'n 


Gr. for 

3 

per- 
cent 
sol'n 


Gr.for 
4 

per- 
cent 
sol'n 


Gr. for 

5 

per- 
cent 
sol'n 


Gr. for 
10 
per- 
cent 
sol'n 


Gr. for 
20 
per- 
cent 
sol'n 


Gr. for 
25 

per- 
cent 
sol'n 


Gr.for 
50 
per- 
cent 
sol'n 


X 


0.228 


0.457 


1.14 2.3 


4.6 


7. 


9.5 


12 


25.3 


57 


76 


228 


1 


0.456 


0.913 


2.29 4.6 


9.3 


14.1 


19. 


24 


50.6 


114 


152 


456 


2 


0.912 


1.83 


4.58 


9.2 


18.6 


28.2 


38. 


48 


101.3 


228 


304 


912 


3 


1.37 


2.74 


6.87 


13.8 27.9 


42.3 


57. 


72 


151.9 


342 


456 


1368 


4 


1.82 


3.65 


9.16 


18.4 


37.2 


56.4 


76. 


96 


202.6 


456 


608 


1824 


6 


2.74 


5.48 


13.75 


27.6 


55.8 


84.6 


114. 


144 


303.9 


684 


912 


2736 


8 


3.65 


7.31 


18.32 


36.8 


74.4 


112.8 


152. 


192 


405.2 


912 


1216 


3648 


12 


5.47 


10.96 


27.5 


55.2 


111.6 


169.2 


228. 


288 


607.9 


1368 


1824 


5472 


16 


7.3 


14.6 


36.64 


73.6 


148.8 


225.6 


304. 


384 


810.4 


1824 


2430 


7296 



Short Rule for Determining Percentages in Mixtures, 

Multiply 480 by the percentage desired and point off two right-hand figures. 
The figures at the left of separatrix will give the number of grains or drops, 
480 being the number of grains to the ounce. Example: 480X4=1920; 
19.20= 19Vf»; 19M> grains to an ounce of liquid, a 4-percent solution. 



WEIGHTS AND MEASURES. 

Table of Solubility. 



67 



Name 


Water 


Alcohol 


Ether 


Glycerin 


Acetanilid 


230 

80 

400 

25 

15 

1 

500 

1 

1 

readily 

12 

1.3 

4 

3 

1 

35 

1 

17 


3.5 


readily 






5 


Acid benzoic 


3 
15 

readily 

1 
readily 

2 

2.5 
readily 


3.5 


10 


Acid boric 


10 


Acid carbolic 

Acid citric 

Acid salicylic 

Acid tannic 


readily 

50 
readily 


readily 
readily 

1 .... ..... 


Acid tartaric 




readily 


Acid trichloracetic 


readily 


Alum 


3 










Ammonium carbonate 








Ammonium chlorid 






5 




1 
35 

10 


50 




Apomorphin hydrochlorid 




Atropin sulphate 




readily 


Borax 




Camphor 


readily 

50 
readily 
4 


readily 

300 
readily 




Caffein 


80 
readily 

0.5 

4 
5000 




Chloral hydrate 


readily 


Cocain hydrochlorid 


Copper sulphate 

Iodin 




4 


10 

50 

3 


3 

6 

15 




Iodoform 




Iodol 


5000 
2 

80 

1 

difficult 

16 

25 

20 

1400 

10 

0.5 

4 

2 

1 

16 

1 

21 

10 

1 

34 

800 

1 

250 




Irons ulphate 


4 


Lithium carbonate 








Magnesium sulphate 








Menthol 

Mercuric chlorid 


readily 

3 

50 


readily 

4 


15 


Morphin hydrochlorid 


5 


Morphin sulphate 




5 


Phenacetin 


16 

readily 
2 






Pilocarpin hydrochlorid 






Potassium acetate 






Potassium bicarbonate 




readily 
4 


Potassium bromid 


200 




Potassium carbonate 




15 


Potassium chlorate 


130 
12 




32 


Potassium iodid 




2.5 


Potassium permanganate 

Potassium sulphate 




explosive 






Potassium tartrate 








Ouinin hydrochlorid 


3 
90 

0.5 
25 

10 
10 
30 












Resorcinol 

Saccharin 


0.5 


5 


Salol 


0.3 




Silver nitrate 

Sodium acetate 


0.6 

3 

2 

12 


readily 
15 


Sodium benzoate 




13 


Sodium bicarbonate .- 






4 











68 



GENERAL THERAPEUTICS. 

Table of Solubility— Continued. 



Name 


Water 


Alcohol 


Ether 


Glycerin 


Sodium bromid . , 


1.2 

2 

3 

6 

1 

3 
31 

0.5 
17* 
1100 

0.6 


5 




1 


Sodium carbonate . . 




5 


Sodium chlorid 






difficult 


Sodium phosphate 






difficult 


Sodium salicylate 


6 




readily 


Sodium sulphate 

Sugar '. 

Tartar emetic 


* 


1 


65 














readily 


Thymol. 

Zinc sulphate 


1 


1 




3 











Number of Drops in a Fluidram. 

Table showing number of drops in a fluidram of different 
liquids, with weight in grains and in grams : 



Name 



Acid, aceticum 

Acid, aceticum dilut 

Acid, hydrochlor 

Acid, hydrochlor. dilut 

Acid, lacticum 

Acid, nitricum 

Acid, nitricum dilut 

Acid, sulphur 

Acid, sulphur, aromat 

Acid, sulphur, dilut 

JEther fortior 

Alcohol , p 

Aqua 

Aqua ammon. fortior 

Chloroform, purificat 

Creosotum . 

Glycerinum 

Hydrargyrum 

Liq. potassi arsenitis 

Oleum caryophylli 

Oleum cinnamomi 

Oleum gaultheriae 

Phenol liquid 

Spiritus ammon. aromat 

Syrupus 

Tinctura aconiti 

Tinctura iodi 

Tinctura opii 





Weight of 1 fluidram 


Drops in 






1 fluidram (60m) 








In grains 


In grams 


108 


58 


3.75 


68 


55 


3.56 


70 


65 


3.62 


60 


56 


3.49 


111 


66 


4.27 


102 


77 


4.98 


60 


58 


3.62 


128 


101 


6.54 


146 


53 


3.43 


60 


5834 


3.79 


176 


39 


2.52 


146 


44 


2.85 


60 


55 


3.56 


66 


50 


3.24 


250 


80 


5.18 


122 


56^ 


3.66 


67 


68 


4.40 


150 


760 


49.24 


57 


55 


3.56 


130 


57 


3.69 


126 


53K 


3.46 


125 


62 


4.01 


111 


59 


3.82 


142 


48 


3.11 


65 


72 


4.66 


146 


46 


2.98 


148 


47 


3.04 


130 


53 


3.43 



PHARMACOPEIA AND PHARMACEUTIC PREPARATIONS. 69 

THE PHARMACOPEIA AND PHARMACEUTIC 

PREPARATIONS. 

The Pharmacopeia. 

In all civilized countries the governments have found it neces- 
sary to issue at certain intervals a standard guide for the regula- 
tion of medicinal preparations kept in the drug stores for dispens- 
ing purposes. This book is termed a Pharmacopeia — from 
pharmakon (a drug) and poiein (to make). The United States 
government, however, does not issue the Pharmacopeia, but it rec- 
ognizes its authority as published by the National Committee of 
Revision, a body composed of members by appointment or elected 
by a convention of the various medical and pharmaceutic socie- 
ties, schools, and United States Medical Corps. The book is re- 
vised every ten years, the present edition being the Eighth Decen- 
nial Revision, published by authority of the United States Phar- 
maceutical Convention, held in Washington, D. C, in 1900. The 
Pharmacopeia furnishes the official standard for the identification, 
purity, strength, and quality, with suitable directions for prepara- 
tion, purification, and preservation, of drugs, chemicals, and me- 
dicinal preparations. The title of the drug is given in Latin, fol- 
lowed by the English name, and, in the case of chemicals, by the 
formula and molecular weight. The preparations contained in 
the Pharmacopeia are therefore termed "official," while all other 
medical substances usually kept in a drug store are termed "non- 
official" or "officinal" — from officin, an ancient name for the 
apothecary's shop. Drugs which were at one time "official" are fre- 
quently termed "obsolete." Quite a number of much used prepa- 
rations which are not contained in the United States Pharma- 
copeia are standardized by having their formulas published in the 
National Formulary, a book published and revised at intervals 
under the direction of the American Pharmaceutical Association. 
Another very large class of remedies are those substances which 
are usually termed the newer remedies. These agents are either 
too new to have gained recognition by the Committee on Revision 
of the Pharmacopeia, or they possess so little real merit that they 



70 GENERAL THERAPEUTICS. 

have been purposely omitted, although they are very largely pre- 
scribed. To somewhat clarify this chaos of grain and chaff, the 
American Medical Association in 1906 created a Council of 
Pharmacy and Chemistry, whose duty it is to select from the 
enormous mass of these articles those which have their definite 
constituents or formulas published, or otherwise comply with the 
rulings of this body. At present (1909) there are about four 
hundred of these articles tentatively approved by the above named 
Council, and they are termed neiv and non-official remedies. 

Besides the Pharmacopeia and National Formulary there are 
books which contain descriptive matter of substances used in 
medicine, with various detailed information. These books are 
compilations and commentaries on the above works, and are 
termed dispensatories. Various books of this character are pub- 
lished in the United States — the United States Dispensatory and 
the National Standard Dispensatory being in general use. 

Pharmaceutic Methods. 

Comminution. — Reducing drugs to smaller pieces. 

Decantation. — Drawing or pouring off a supernatant liquid 
into another vessel. 

Desiccation, or Drying. — To drive off some volatile constitu- 
ent from the solid, the fixed residue being the portion desired. 
Crude drugs are subjected to this method to reduce their bulk, 
to assist preservation, and to facilitate comminution. Drying 
may be accomplished in spreading the drugs in airy lofts, or by 
heat in drying closets. Care must be taken not to injure the 
volatile ingredients of the drugs. 

Distillation. — Evaporation of a liquid and condensing the 
vapor into a liquid in a separate vessel. Fractional distillation 
is the process of separating a mixture of liquids of different boil- 
ing points by distillation. 

Evaporation. — Vaporizing a solvent from a solution so as to 
concentrate the dissolved substance. 

Expression. — Separation of liquids from solids by pressure. 

Exsiccation, or Calcination. — Depriving a solid of its mois- 
ture or volatile constituents by heat without fusion. 



PHARMACOPEIA AND PHARMACEUTIC PREPARATIONS. 71 

Filtration. — Separation of liquids from suspended solids by 
pouring them through a filter medium — as filter paper, charcoal, 
sand, etc. 

Maceration. — Dissolving soluble active constituents of drugs 
by suspending them in a menstruum for a sufficient length of 
time. 

Precipitation. — Separating solids from their solvents, which 
is usually accomplished by chemic or physical means. 

Percolation, or Displacement. — A process of exhausting a 
drug by a suitable menstruum. It consists in "subjecting a sub- 
stance or mixture of substances in powder, contained in a vessel 
called a percolator, to the solvent action of successive portions of 
a certain menstruum in such a manner that the liquid, as it trav- 
erses the powder in its descent to a receiver, shall be charged 
with the soluble portion of it, and pass through the percolator free 
from insoluble matter." (U. S. Pharmacopeia.) 

Solution. — The diffusion of solid molecules in a liquid in such 
a manner as to become widely separated, with no solid particles 
discernible by any means. A simple solution is purely a physical 
process, as the substance undergoes no alteration. A chemic 
solution is a chemic alteration of the dissolved body by the solvent. 
If a solution is fully charged with the dissolved substances so as 
not to retain any more of it, it is termed a saturated solution. A 
saturated solution of one substance is still capable of dissolving 
other bodies to a limited extent. Circulatory solutions dissolve 
or exhaust a substance which is suspended in the solvent. The 
process of making a simple solution depresses and that of a 
chemic solution raises the temperature of the solvent. 

Sublimation. — Separating a volatile from a nonvolatile solid. 

Trituration. — Rubbing a substance to a very fine powder in a 
mortar. 

Pharmaceutic Preparations. 

Capsules ( Capsules V — Gelatin coverings of various sizes for 
drugs. 

Cerates (Cerata). — Unctuous preparations similar to oint- 
ments, having for their bases the simple cerate, composed of 30 



72 GENERAL THERAPEUTICS. 

parts white wax, 20 parts petrolatum, 50 parts benzoinated lard — 
as camphor cerate. 

Collodions (Collodia) . — Liquid preparations having for their 
base a solution of gun cotton (pyroxylin) in a mixture of ether 
and alcohol — as flexible collodion. 

Confections (Confectiones). — Medicinal substances formed 
into a mass with sugar, honey, and water — as confection of rose. 

Decoctions (Decoctiones.) — Vegetable substances boiled in 
water and strained — as decotion of sarsaparilla. 

Elixirs (Elixiria). — Sweetened, spirituous preparations con- 
taining medicinal substances in small quantities — as elixir of 
gentian. 

Emulsions (Emulsia). — Aqueous preparations in which oils, 
oleoresins, balsams, resins, or other substances which are in- 
soluble in water are suspended by means of gum or other viscid 
excipients — as cod-liver oil emulsion. 

Extracts (Extracta). — Solid or semi-solid substances of ac- 
tive principles of drugs — as extract of opium. 

Fluid Extracts (Fluidextracta). — Active principles of 
drugs prepared by percolation. They are liquid, and one gram of 
the drug corresponds to one cubic centimeter of the finished prod- 
uct — as fluid extract of ergot. 

Gargles (Gargarisma). — Mixtures or solutions for application 
to the pharynx or to the mouth. 

Glycerites (Glycerita). — Mixtures or solutions of medicinal 
substances with or in glycerin — as glycerite of tannic acid. 

Honeys (Mellita). — Vehicles for drugs — as honey of rose. 

Infusions (Infusia). — Comminuted drugs exhausted with hot 
or cold water — as infusion of digitalis. , 

Injections (Injectiones) . — Liquid preparations for introduc- 
tion into the cavities of the body by means of a syringe. 

Juices (Succi). — Expressed juices of fresh drugs — as lemon 
juice. 

Liniments (Linimenta). — Liquid ointments to be applied 
with friction to the skin — as soap liniment. 

Lotions (Lotiones). — Mixtures or solutions of medicinal 
agents for external application. 



PHARMACOPEIA AND PHARMACEUTIC PREPARATIONS'. 73 

Masses (Mass^e). — Dough mixtures of pilular consistency for 
making pills — as mass of mercury. 

Mixtures (Mistuile). — Solids suspended in aqueous liquids 
— as chalk mixture. 

Mucilages (Mucilagines). — Gums dissolved in water — as 
mucilage of acacia. 

Ointments (Unguenta). — Soft, fatty mixtures melting by 
friction at body temperature — as zinc ointment. 

Oleates (Oleata). — Solutions of metallic salts or alkaloids in 
oleic acid — as oleate of mercury. 

Oleoresins (Oleoresin^e). — Natural — as copaiva and turpen- 
tine; or artificially prepared by extracting drugs with ether — as 
oleoresin of ginger. 

Papers (Charts). — Paper impregnated with medicinal sub- 
stances — as mustard paper. 

Pills (Pilulje). — Small spherical bodies, containing medicinal 
substances by aid of some vehicle and covered with various sub- 
stances — as cathartic pills. (Dragee, granule, and bolus are modi- 
fications of pills.) 

Plasters (Emplastra). — Adhesive, fatty, or resinous com- 
pounds spread on textile fibers, leather, muslin, etc., and are either 
dry or soft — as lead plaster. 

Poultices ( Cataplasm ata). — Means of applying heat and 
moisture to certain parts of the body — as cataplasm of kaolin. 

Powders (Pulveres). — Drug mixtures in very fine state of 
division — as Dover's powder. 

Pesins (Resin^e). — Natural exudations — as rosin; or artifi- 
cially prepared principles of drugs — as resin of jalap. 

Solutions (Liquores). — Watery solutions of non-volatile sub- 
stances — as solutions of magnesium citrate. 

Spirits (Spiritus). — Solution of volatile substances in alco- 
hol — as spirits of peppermint. 

Suppositories (Suppositoria). — Medicines mixed with cocoa 
butter and formed into cones intended for introduction into the 
rectum or vagina; for urethral use they are called bougies — as 
glycerin suppositories. 



74 GENERAL THERAPEUTICS. 

Syrups (Syrupi) . — Solutions of various kinds containing large 
quantities of sugar — as syrup of tolu. 

Tinctures (Tincture). — Solutions of medicinal active con- 
stituents of drugs in an alcoholic menstruum — as tincture of kra- 
meria. 

Triturations (Triturationes). — Intimate mixtures of one 
part of the substance with nine parts of sugar of milk. 

Troches -(Trochisci). — Small compressed tablets or cakes of 
some medicinal substances with some vehicle — as troches of san- 
tonin. 

Vinegars (Aceta). — Solutions of active principles of drugs in 
dilute acetic acid— as vinegar of squills. 

Waters (Aqu^e). — Solutions of volatile substances in water — 
as rose water. 

Wines (Vina) . — Solutions of medicinal substances in wine— as 
wine of opium. 



PART II 
PHARMACO-THERAPEUTICS. 



ANTISEPTICS. 

At present it is generally recognized that the breaking down 
of highly organized bodies, when subjected to certain * causative 
conditions, is brought about by the activity of minute vegetable 
organisms — the bacteria. This process is called putrefaction, or, 
under certain conditions, fermentation. These terms are synony- 
mous, and are applied to strictly analogous processes, with 
this differentiation — putrefaction refers to the decomposition of 
animal proteins, while fermentation is restricted to the cleavage 
action of bacteria and of certain ill-defined bodies known as fer- 
ments on vegetable material. The presence of certain bacteria 
is instrumental in the production of severe physiologic changes, 
resulting in the various vital phenomena known as infectious 
diseases. As soon as this fact became recognized, investigators 
directed their attention to the discovery of agents capable of 
inhibiting or destroying the action of these germs, with the 
object of rendering infected or septic conditions perfectly clean, or 
antiseptic. 

By the term sepsis, then, we understand the existence of a con- 
dition in which bacterial infection and its sequelae — fermentation 
or putrefaction — is brought about by the presence of germs or 
their products, while asepsis implies an entire freedom from such 
infection — that is, an aseptic condition. If a primarily septic con- 
dition is changed by some method or means that inhibits the 
growth of putrefactive organisms, antisepsis is secured. Conse- 
quently antiseptics are chemic agents that merely inhibit the action 
and growth of bacteria, while germicides destroy the vitality of the 
infective organisms. Disinfectants also kill the bacteria, and 

75 



76 PHARMACO-THERAPEUTICS. 

chemically change their poisonous products to some inert com- 
pounds. Disinfectants must, therefore, be germicides. Thus it 
will be seen that an antiseptic is not necessarily a germicide or 
a disinfectant — that is, glycerin will inhibit the growth of certain 
bacteria, and is therefore antiseptic, but it has very little or no 
power to destroy the micro-organisms themselves or their spores, 
and consequently possesses no germicidal or disinfectant prop- 
erties. On the other hand, formaldehyd solution is an effective 
germicide, possesses also powerful disinfectant properties, and is 
successfully employed for both purposes, while milk of hypo- 
chlorid of lime is extensively used as a disinfectant, which, of 
course, incidentally means germicidal action. 

Quite frequently putrefactive processes are accompanied by 
the production of malodorous gases arising from the formation of 
new compounds. Again, agents are employed to destroy these 
offensive odors, and such agents are termed deodorants. The true 
deodorants usually have very little or no antiseptic action — as 
iron sulphate. If an agent is employed solely for its cleansing 
power, either mechanically or chemically — as soapsuds — it is 
termed a detergent, while all those chemicals that possess the 
power to inhibit the action of ferments are called antizymotics. 

The action of antiseptics depends on their chemic relationship 
to the albumin of the cell; they act as poisons, and are therefore 
closely related to caustics and astringents. The ideal antiseptic 
would be one that inhibits or destroys the bacteria and their 
products without seriously injuring the cell of the host. Accord- 
ing to pur present conception of biologic laws, the search for such 
a material is apparently fruitless. 

Antiseptics are usually divided into those used for external or 
local application and those employed internally. External anti- 
septics include all those agents that are used on the skin, the 
external mucous surfaces, including the oral cavity, wounds, and 
ulcers, the intestinal tract, the bronchi and lungs, and, in a round- 
about way, the urinary tract, while the destruction of infectious 
material on instruments, clothing, rooms, food, etc., is accom- 
plished by disinfectants. The destruction of all forms of bacteria 
and their products, and their removal from external surfaces, is 



ANTISEPTICS. 77 

referred to as sterilization, and is usually performed by means of 
heat. 

The administration of internal antiseptics is based on the 
supposition that the blood and the body juices become saturated 
with them to such an extent as to kill or neutralize the bacteria 
and their waste products without harming the tissues themselves. 
As yet very little is known about the action of antiseptics when 
administered in the above manner. Clinical observations show, 
however, that certain infectious diseases — as malaria, syphilis, 
acute articular rheumatism, probably sepsis, and a few others — 
are positively influenced by such treatment, and that their uses 
are therefore justified. Recently efforts have been made to intro- 
duce antiseptic medication by inunction or by intravenous injec- 
tion — as quinin in malaria, mercury salts in syphilis, silver com- 
pounds and formaldehyd solution in sepsis, etc. While such pro- 
cedures, per se, may be justified, they should not be followed 
indiscriminately. 

When we speak about the potency of any given antiseptic, it 
should be remembered that this potency is only relatively ex- 
pressed. We have as yet no accepted standards of antiseptic 
strength. Various efforts have been made in this respect; for 
instance, Rideal and Walker have attempted to introduce the so- 
called "carbolic acid coefficient," The principle of their methods 
is very simple: "Solutions of the disinfectant to be tested are made 
up in various strengths with distilled water and compared as to 
their germicidal action on, for example, the typhoid bacillus with 
a solution of phenol (carbolic acid) — say, 1 part in 100. A 
strength of the disinfectant will ultimately be found that will be 
identical in its germicidal powers with the known phenol solu- 
tion — that is, one that will kill the typhoid bacilli in just the 
same time as the latter. Suppose the solution that does this to 
be one of a strength of 1 part in 80. We should now be able to 
assert that, under the conditions of the experiment, 1 part in 80 
of the disinfectant to be tested will perform the same work as 1 
part in 100 of phenol. Its strength might therefore be stated as 
8 %oo, or A as compared with phenol, which would be its carbolic 
acid coefficient. If, on the other hand, it were found that 1 part 



78 



PHARMACO-THERAPEUTICS. 



in 400 did the same work as 1 part in 100 of phenol, its carbolic 
acid coefficient would be 4." 1 The scheme has not met with uni- 
versal acceptance on account of the many difficulties encountered 
in establishing an international standard. For this very reason 
comparatively little advantage, except in a general way, is derived 
from the many tabulations of the potency of antiseptics as 
employed for practical purposes. 

In the following table the more common antiseptics are ar- 
ranged approximately according to their relative strength. It 
must be borne in mind, however, that the absolute strength of 
these antiseptics can be correctly determined only by laborious 
tests, using germs of the same family, and exposing them in equal 
numbers and under absolutely equal conditions to nutrient media, 
temperature, and time; in other words, they have to be standard- 
ized. 

The table is compiled from the various publications of Koch, 
Sternberg, Miquel, and Kitasato. 



Antiseptics. 

Extremely Strong Antiseptics. 



/ 



Solution hydrogen dioxid. Mercuric chlorid. 
Solution of formaldehyd. v Chinosol. 


Silver nitrate. 
Sublamin. 




Very Strong Antiseptics. 


Iodin. 
Lysol. 
Thymol. 


Creolin. 

Lysoform. 

Creosote. 

Strong Antiseptics. 


Cresol. 
Phenol. 


Cupric sulphate. 
Salicylic acid. 


Zinc chlorid. 
Chloroform. 


Aluminum chlorid. 
Boric acid. •* 




Medium Strong Antiseptics. 


Potassium permanganate. Quinin sulphate. 
Alcohol. Benzoic acid. 
Ferrous sulphate. Sodium borate. 


Arsenic trioxid acid. 
Acetanilid. 




Weak Antiseptics. 




Ammonium chlorid. 


Sodium chlorid. 


Glycerin. 



y 



1 Andrews: Lessons in Disinfection and Sterilization, 1906. 



ANTISEPTICS. 79 

The following table gives the concentration of the various anti- 
septics in which they can be utilized in the mouth according to 
Miller: 1 



Mercuric chlorid 1 : 2,000 

Benzoic acid 1 : 300 

Salicylic acid 1: 300 

Hydronaphtol 1:1,500 

Lysol 1:200 

Phenol 1:100 

Boric acid 1 : 50 

Zinc phenolsulphonate 1 : 250 

Solution aluminum acetate. 1:20 
Solution hydrogen dioxid. . .2-4: 100 

Saccharin 1 : 400 



Saccharin, easily soluble ... 1 : 120 

Potassium chlorate 1 : 40 

Potassium permanganate . . 1:2,500 

Thymol 1:2,000 

Eugenol 1:750 

Oil of cinnamon 1 : 400 

Oil of cloves 1 : 550 

Oil of eucalyptus 1 : 625 

Oil of peppermint 1 : 600 

Oil of pinus pumillio 1 : 360 

Oil of wintergreen 1 : 530 



All those chemicals that are generically termed "antiseptics" 
may, for the sake of convenience, be grouped under the following 
headings : 

1. Salts of the heavy metals, their oxids, and their organic 
compounds. 

2. Acids, alkalies, halogens and their derivatives. 

3. Solutions which evolve nascent oxygen. 

4. Antiseptics of the aromatic series. 

5. Antiseptics of the marsh gas series. 

6. Essential oils, their derivatives, and their synthetic substi- 
tutes. 

Salts of the Heavy Metals, their Oxids, and their 
Organic Compounds. 

The salts of the heavy metals form an important group of those 
agents that collectively are termed antiseptics. Metals, in their 
pure state, do not usually induce any serious symptoms in the 
living organisms unless their salts or oxids are formed. Mercury, 
copper, silver, etc., may pass unaltered through the body without 
causing poisonous effects. The soluble and insoluble salts of 
gold, nickel, copper, or tin are not absorbed by the intestines, 
even if they are administered continuously for months; hence 
vessels that are made from such metals, or that are covered with 

1 Miller: Die Mikroorganismen der Mundhohle, 1893. 



80 



PHARMACO-THERAPEUTICS. 



a continuous coating thereof, and that are used for culinary pur- 
poses are free from danger if kept clean. Silver salts, if adminis- 
tered for a longer period, may be absorbed and deposited in a re- 
duced form in the connective tissues, causing a grayish discoloration 
of the skin (argyria). Lead, bismuth and mercury salts are readily 
absorbed, and consequently, when administered in continuous 
doses, produce typical chronic intoxications — lead colic, lead palsy, 
and mercurialism. When administered in sufficiently large doses, 
the absorbable salts of the heavy metals cause collapse and death ; 
in small doses they produce necrosis of the specific tissues, affecting 




Figure 5. 

Culture Plate with Pack's Cylinders and Abbey's Noncohesive Foil, a, b, c, d, annealed; 
e, f, g, not annealed. Tbe latter did not allow any growth to appear within close proximity 
(Millei .) 

primarily the liver and the kidneys. Certain metals — as mercury, 
bismuth, iron, etc. — are readily excreted by the lower bowel ; some 
metals, as mercury, show a predilection for diseased mucous mem- 
branes. The constant irritation produced by their excretion 
through the saliva causes various forms of stomatitis (mercury 
and bismuth), and in cases of lead salts causes a deposit of lead 
sulphid along the gingival line, known as the "lead line." Some 
few metals, in their pure state, possess antiseptic action. Accord- 
ing to Miller, gold, silver, and mercury — and, to a less extent, 
copper, nickel, and zinc — inhibit the growth of certain forms of 



ANTISEPTICS. 81 

pathogenic micro-organisms, while iron, tin, and lead practically 
show no action. This antiseptic action is the result, according to 
Behring, of the reaction of certain waste products of the bacteria 
with those metals that are capable of forming small quantities of 
soluble salts and that diffuse through the medium. 

The salts of the heavy metals are principally protoplasm poisons, 
but differ widely in their toxic action. In concentrated solutions 
they may act as severe caustics, while, when well diluted, only 
astringent effects are obtained. The soluble metallic salts possess 
an astringent and nauseating, sweetish taste. If swallowed in 
more or less concentrated solutions, they induce vomiting, which 
is so very effective with certain metallic salts that they are fre- 
quently employed as reliable emetics — as copper sulphate and zinc 
sulphate. The insoluble salts of the heavy metals do not, of 
course, possess any germicidal action, or even produce physiologic 
effects — as, for instance, the insoluble mercury sulphid (artificial 
cinnabar). It should be remembered, however, that insolubility 
in water does not necessarily mean insolubility in the body juices. 
While the latter are largely aqueous in their nature, they contain 
sodium chlorid, fatty acids, albumin, etc., which are prone to 
produce soluble double salts by acting on the metallic salts. On 
this supposition we are able to explain why the otherwise insoluble 
calomel or bismuth subnitrate produce definite action when 
brought in contact with the surface of a wound or of the intestines. 
The local action of the metallic salts does not depend upon 
the, combination of their molecules as a whole, but on the dissocia- 
tion of their ions and oxids in solution. 

To more readily comprehend the effect of a solution — the dis- 
sociation of a solid, liquid, or gas in a solution — on tissue, it is 
necessary to understand the physical laws governing this process — 
that is, the theory of electrolytic dissociation of Arrhenius. When 
acids, salts, or bases are dissolved in a liquid, usually water, the 
molecules of these compounds break up into ions. The resulting 
solution possesses the property of conducting an electric current, 
and is, according to Faraday, called an electrolite. When a cur- 
rent passes through the electrolytic solution, the latter undergoes 
certain changes which are generically termed electrolysis. If, 



82 PHARMACO-THERAPEUTICS. 

on the other hand, a liquid has not the power of dissociating mole- 
cules into ions, it can not conduct an electric current. Now, 
according to Arrhenius, the conductibility of an electrolyte is 
proportionately depending on (1) the number of ions, (2) the 
relative electric charge of these ions, and (3) the speed of the 
ions. Furthermore, the resulting ions depend, with limits, on 
the degree of dilution of the solution ; a certain definite dilution 
dissociates completely all molecules, and further dilution merely 
separates the ions farther from each other. For example, if 
mercuric chlorid (HgCl 2 ) is dissolved in water, one positive Hg 




Figure 6. 

Imaginary Diagram of a Solution of Mercuric Chlorid in Water. The atoms of mercury are 
represented by the large circles marked Hg, the chlorin atoms by the smaller circles marked CL 
Some of the mercury atoms are depicted joined on the two chlorin atoms to form the salt- 
Some are depicted as dissociated " ions " swimming about in the free state. The signs — and — 
attached to these indicate positive (cations) and negative (anions) electric charges. (Andrews.) 

ion and two negative CI ions are the result. All ions are charged 
with positive or negative electricity. The negatively charged ions, 
which travel to the positive pole, are termed anions, while those 
charged with positive electricity and traveling toward the negative 
pole are termed cations. We may express the ions of a com- 
pletely dissociated mercuric chlorid solution as Hg-j- and CI — . 
Water has, so far as known, the greatest dissociating power, with 



ANTISEPTICS. 83 

the possible exception of hydrogen dioxid. Formic acid, methyl 
alcohol, ethyl alcohol, ammonia, and others are, however, known 
to possess this peculiarity to a greater or less degree. The organic 
compounds are much less dissociated than the inorganic salts, and 
their ions are more complex and are very little understood at 
present. Although all definite soluble bodies possess more or less 
the same property, at present we can speak only of the salts of 
the metals and alkalies with some positive knowledge. 

The practical application of the above theories of physical chem- 
istry in relation to the action of the metallic salts on bacteria is 
very significant. Our present knowledge on this subject is largely 
the result of experiments of Paul and Kronig, which were pub- 
lished in the various scientific journals. It is impossible to relate 
the details of these experiments, but the reiteration of a few 
important points may serve for a better comprehension of the 
theory of electrolytic dissociation. As subjects for experiments, 
the authors used the spores of anthrax and the staphylococcus 
pyogenes aureus (a pus organism). Now, if we remember that 
an electrolyte in solution is dissociated into its ions only in part 
when the solution is not infinitely diluted, then the effect of this 
solution must be attributed to the combined actions of the ions 
and the undissociated molecules present in it. Paul and Kronig 
investigated, first of all, the role played by the ions of the undis- 
sociated molecules in the disinfectant solutions. For this purpose 
the germicidal power of several mercury compounds, which are 
dissociated to different degrees in aqueous solutions, was examined. 
The following are the names of a few of these compounds, ar- 
ranged in the order of their decreasing degree of dissociation : 

1. Mercuric chlorid, HgCL. 

2. Mercuric bromid, HgBr 2 . 

3. Mercuric cyanid, Hg(CN) 2 . 

If the germicidal action of the halogen ions and the undisso- 
ciated molecules is slight as compared with that of the Hg ions, 
then the disinfectant action of these solutions will be dependent 
in the main on the concentration of the Hg ions — that is, on the 
degree of dissociation of these salts. We may conclude from these 
experiments that the greater the dissociation of the mercury com- 



84 PHARMACO-THERAPEUTICS. 

pounds — that is, the greater the number of mercury ions present 
in the unit volume of the given solution — the greater is its disin- 
fectant action. Furthermore, it is not so much the concentration 
of the solution alone, but also the specific action of the metallic 
salt, that influences its power as a disinfectant; if the cation of 
the metallic salt solution is very complex, it is less concentrated 
and consequently less active. Similar results were obtained by 
Paul and Kronig with silver, gold, and copper salts. The investi- 
gation of the germicidal action of acids and bases has also brought 
to light many interesting facts. A few of the general conclusions 
drawn by the above named authors from their experiments are 
as follows : 

1. The germicidal action of solutions of acids runs parallel to 
that of their degree of dissociation — that is, parallel to the number 
of hydrogen ions contained in the unit volume of solution. The 
anions, and also the undissociated molecules of hydrofluoric, nitric, 
and trichloracetic acid, have a specific toxic effect on bacteria. This 
toxicity, when compared with the germicidal effects of the hydro- 
gen ions, becomes insignificant with progressive dilution. 

2. The disinfectant action of bases — as calcium, sodium, lith- 
ium, and ammonium hydroxid — runs parallel to the number of 
free hydroxyl ions contained in the unit volume of the solution. 

As is the case in every investigation, new problems arise here 
also. Thus, for example, it has been found that, while such salts 
as corrosive sublimate or silver nitrate, when dissolved in absolute 
methyl or ethyl alcohol, have only slight germicidal powers, cor- 
responding to the slight dissociation in these media, aqueous 
solutions of these salts show an increased disinfectant action when 
a not too large amount of these alcohols is added thereto. 

The same metals attached to different acids produce different 
effects, depending on the free acid— that is, the milder acetic acid 
formed from lead acetate acts more as an astringent than the 
stronger nitric acid formed from lead nitrate. This latter acid 
is highly corrosive and acts as an irritant. The actions of the 
various acids that may be attached to one metal differ widely in 
their therapeutic effect — so much so that all intermediate stages 
from a mild astringent to a widespread necrosis may be produced. 



ANTISEPTICS. 85 

The chlorids and the nitrates form the most corrosive acids, the 
sulphates are milder, while the iodids and bromids are still less 
irritating. The mildest acids are those formed from the organic 
salts. The albuminates of the metals do not irritate unless the 
poisonous effects of the metals themselves are manifested. 

The antiseptic properties of the more important metals may be 
arranged according to the following scale, beginning with the 
mildest one: Iron, aluminum, lead, copper, zinc, silver, mercury, 
etc. The organic metallic compounds and the double salts of 
metals form weak precipitates with albumin ; they are less irri- 
tating, and only slowly dissociate and diffuse over the parts. 

Within recent years, through the investigations of Bredig, solu- 
tions of very pure metals in water have been introduced for anti- 
septic purposes. These solutions are variously termed colloidal 
solutions, pseudo-solutions, or simply sols. It seems paradoxical 
to speak of a water-soluble gold, silver, mercury, etc. It must be 
borne in mind, however, that such solutions are merely mechanical 
suspensions of extremely fine particles of metal — metals in their 
amorphous state in water. Accordingly these pseudo-solutions of 
colloids (from the Latin colla, glue) are physically different from 
true solutions— the crystalloids. Most likely the application of 
metals in their colloidal state will gain some prominence in the 
near future. Silver, mercury, copper, iron, and gold are produced 
at present in this form, and no doubt other, metals will soon 

follow. 

For some time past chemists have endeavored to remedy the 
irritating properties of the inorganic metallic salts by preparing 
synthetically organic metallic compounds. In the last few years 
quite a number of these compounds appeared on the market, 
especially organic salts of silver and mercury. Some of these 
compounds give extreme satisfaction, and it seems safe to prog- 
nosticate a good future for their general use. 

In general, the metallic salts have an acid reaction, and pre- 
cipitate albumin by virtue of their acid or basic components. 
These precipitates differ very markedly in regard to their density, 
and depend largely on the various metallic salts employed. Silver 
nitrate, for instance, produces a hard, compact, and dry precipi- 



86 PHARMACO-THERAPEUTICS. 

tate, which is definitely localized and which prohibits the further 
penetration of the salt, while zinc chlorid produces a loose, floccu- 
lent mass resembling the precipitate of alkalies, and this sponge- 
like precipitate does not prohibit the further penetration of the 
salt in depth and width. 

The antiseptic action of the metallic salts depends largely on the 
formation of metallic compounds when brought in contact with 
proteins or albumins. Usually these newly formed albuminates 
are insoluble in water; some, however, are soluble in an excess of 
proteins — as mercury — and some will dissolve in solutions of 
neutral salts (sodium chlorid) or organic acids (tartaric or citric 
acid) . 

When a solution of a metallic salt is applied to a mucous mem- 
brane or to the surfaces of a wound, the albumin is at once pre- 
cipitated, and the acid with which the metal is combined is set 
free. Thus a more or less dense and continuous film is formed 
over the surface, which acts as a mechanical protective to the parts 
involved, lessening, or even completely checking, the further 
penetration of the solution into the deeper structures. The free 
acid acts as an irritant, which stimulates the circulation of the 
involved part, thereby increasing cell activity and effusion of 
exudates. The germs that are present, being largely albuminous 
in their nature, are acted on in the same manner as the superficial 
cells; they become coagulated and the surrounding medium is 
changed simultaneously to an unfavorable pabulum for the new 
growth of micro-organisms. The liquid exudates, being freed 
from their protein, become more diffusible and are more easily 
absorbed, while the blood vessels slightly contract and become 
less permeable. 

Corrosive Mercuric Chlorid; Hydrargyri Chloridum Corro- 
sivum, U. S. P. ; Hydrargyri Perchloridum, B. P. ; HgCL. 

Etymology. — From the Greek hydrar gyros- (liquid silver). 

Synonyms. — Mercurius sublimatus corrosivus, corrosive subli- 
mate, perchlorid or bichlorid of mercury ; sublime corrosif , F. ; 
Aetzender Quecksilbersublimat, G. 



ANTISEPTICS. 87 

Source and Character. — Mercuric chlorid is obtained by 
subliming a mixture of mercuric sulphate, sodium chlorid. and 
some black oxid of manganese. The latter is added to prevent the 
formation of calomel. 

HgSO,+2NaCl+Mn0 2 =HgCl 2 +Na 2 S0 4 +Mn0 2 . 

It occurs in heavy, colorless rhomboid crystals or masses, odor- 
less, and has an acrid and persistent metallic taste ; permanent in 
the air. When in fine powder it is soluble at 60° F. (16° C.) in 
13 parts of water, in 3 parts of alcohol, in 4 parts of ether, in 2 
parts of boiling water, and in about 14 parts of glycerin. It is 
incompatible with alkalies and their carbonates, potassium iodid, 
lime water, tartar emetic, silver nitrate, albumin, soaps, and tannic 
acid. It attacks steel and nickel-plated instruments. 1 

Average Dose. — 1 / 20 grain (0.003 Gm.). 

Preparations. — 

Liquor Hydrargyri Perchloridi, B. P. 1 part dissolved in 875 
parts of distilled water. Average dose, 1 / 2 fluidram (2 Cc). 

Lotio Hydrargyri Flava; Yellow Wash (Aqua Phagedenica) . 
Mercuric chlorid, 25 grains (1.5 Gm.) dissolved in lime water, 
16 ounces (473.17 Cc). For external use. 

Sal Alembroth (Salts of Wisdom). Equal parts of mei curie 
chlorid and ammonium chlorid. 

Medical Properties. — Antiseptic, disinfectant, caustic, antii 
phlogistic, specific. 

Local Action. — Applied on the unbroken skin, mercuric 
bichlorid produces little irritation unless kept there for some time. 
On wounds and mucous surfaces, weak solutions are antiseptic and 
disinfectant; if concentrated, they are caustic. Solutions are 
readily absorbed, and they may produce poisonous effects. Mer- 
curic chlorid, like all metallic salts, coagulates albumin and com- 
bines with the protoplasm of the cells. This precipitated albumi- 
nate of mercury is, however, soluble in an excess of albumin or 
in sodium chlorid solutions. For the sake of convenience, corro- 
sive sublimate tablets are now prepared, having tartaric acid, citric 



1 Regarding the action of corrosive sublimate on metallic objects, it should be remembered 
that it not only causes a precipitate of metallic mercury on them, but the disinfectant solution 
is also abolished in proportion as the mercury is precipitated. 



88 PHARMACO-THERAPEUTICS. 

acid, ammonium chlorid, etc., as a component to render the 
mercury more soluble and to prevent its precipitation as an insolu- 
ble compound. (Laplace.) Bernays' antiseptic tablets are a con- 
venient form for making extemporaneous solutions with meas- 
ures of water ordinarily used. Each tablet contains l 41 / 50 grains 
of mercuric chlorid and 87 / 100 grains of citric acid. One tablet 
dissolved in 4 ounces of water gives a 1:1,000 solution. These 
tablets are frequently colored (red or blue) with small quantities 
of anilin dves. 

Therapeutics. — Mercuric chlorid is still extensively used in 
antiseptic surgery. For disinfectant purposes a solution of 1 : 1,000 
is employed, while as a general antiseptic 1 :5,000 is quite sufficient. 
In dentistry its application as a mouth wash, although very effi- 
cient, is not to be recommended; the superficial epithelial cells of 
the mucous lining of the mouth are readily destroyed by its pro- 
longed use. As a disinfectant for putrescent root canals and for 
abscesses and fistulas, a slight acid solution of 1 part in 1,000 parts 
of hydrogen dioxid solution is one of the most effective agents at 
our command. It is also recommended for the disinfection of 
pyorrhea pockets (a glass syringe with a platinum point should be 
used). Miller has recommended its application with thymol as 
a mummifying agent for pulp stumps; teeth treated in this man- 
ner usually become badly discolored (mercuric sulphid being 
formed), the color ranging from a greenish-blue to a dark blue- 
black. Administered internally, corrosive sublimate, like all other 
mercurials, is changed to a double sodium and mercury chlorid, 
which is soluble in an excess of sodium chlorid. It enters the 
blood very rapidly, but seems to have no direct action on the 
blood. It quickly leaves the blood and enters the tissues, where 
it may remain indefinitely; here it manifests its specific influence 
on syphilis. As it is very slowly excreted, the secretions of all the 
glands (saliva, milk, sweat, urine, and bile) are stimulated. It 
is a powerful sialogogue, causing an increased flow of saliva which 
contains mercury. The saliva has a metallic taste, and acts as 
an irritant on the mucous membrane of the mouth, which may 
result in a typical decubital ulceration, known as mercurial 
stomatitis. 



ANTISEPTICS. g9 

Toxicology. — If swallowed in poisonous doses, intense pain 
in the throat, stomach, and bowels is produced, accompanied by 
nausea, retching, bloody vomiting, diarrhea, cold sweats, and diffi- 
cult respiration, followed by convulsions and death. The treat- 
ment should be primarily directed to relieve the gastro-enteritis ; 
white of eggs beaten up with water, or milk, to form insoluble 
albumin compounds, should be freely given, or wheat flour may 
be substituted. The stomach should be washed out before the 
acid contents render the albumin compounds soluble. The after 
effects should be treated with opiates, counterirritants, and demul- 
cent drinks. Two grains have been known to kill a man in half 
an hour, and an infant died from the constitutional effects of 
corrosive sublimate sprinkled on an excoriated surface. 

Antiseptic Solution. 

$. Tablet, antiseptic. Bernays No. j 

Aq. hydrogen, dioxid. fl^ i y (120 Cc.) 

M. 
Sig. : Antiseptic solution. 

Mercuric Cyanid; Hydrargyri Cyanidum; Hg(CN) 2 . It forms 
colorless crystals, without odor and with a bitter, metallic taste. 
It is soluble in about 12 parts of water, in 15 parts of alcohol, and 
in 3 parts of boiling water. Mercuric cyanid resembles corrosive 
sublimate closely in its action, but it is less active and much less 
irritating. For this reason it is used hypodermically in syphilis. 
It does not attack steel instruments very readily. 

Mercurol; Mercury Nucleinate. It is an organic compound 
of mercury and nucleinic acid (yeast neuclein), containing about 
10 percent of metallic mercury. It appears in the form of a 
brownish- white powder, soluble in water, but insoluble in alcohol. 
It does not precipitate albumin, but has marked bactericidal 
power, and possesses the typical action of a soluble mercury 
compound. It is used in 1 to 2-percent solutions as an antiseptic. 

Sublamin. It is an organic mercury compound, which is chem- 
ically defined as mercuric sulphate-ethylendiamin. It is com- 
posed of 3 molecules of mercuric sulphate and 8 molecules of 
ethylendiamin, and contains about 44 percent of mercury. It 
occurs in white needle-like crystals, which readily dissolve in 



90 PHARMACO-THERAPEUTICS. 

water, with an alkaline reaction, but which are only slightly solu- 
ble in alcohol. Sublamin is recommended for the disinfection of 
the skin, hands, etc., in 1:1,000 solution. As it does not precipi- 
tate albumin, it possesses greater penetrating power than mercuric 
chlorid, and is less poisonous, much less irritating, and more readily 
soluble than the latter salt. It is stated that it does not attack 
metallic instruments. This statement is not correct; sublamin 
attacks metallic surfaces, although less so than corrosive sublimate. 

Sapodermin. It is an albuminate of mercury in the form of a 
soap in which the mercuric chlorid is incorporated with a refined 
stearin and glycerin. It is principally used for hand disinfection. 

Hermophenyl; Sodio-Mer curie Phenol Disulphonate. It is a 
very soluble mercuric compound, which has gained some reputa- 
tion as an antisyphilitic. Recently it has been recommended as 
a substitute for mercuric chlorid in dentistry. 

Red, Mercuric Oxid; Hydrargyri Oxidum Rubrum, U. S. P., 
B. P. ; HgO ; Red Precipitate. It is an orange-red amorphous 
powder. It is insoluble in water and in alcohol. 

Yellow Mercuric Oxid; Hyrargyri Oxidum Flavum, U. S. P. ; 
HgO. It is a light orange-yellow amorphous powder. 

Red Mercuric Iodid; Hydrargyri Iodidum Rubrum, U. S. P., 
B. P. ; Hgl 2 . It is a scarlet-red amorphous powder. Average dose 
V20 grain (0.003 Gm.). 

Yellow Mercurous Iodid; Hydrargyri Iodidum Flavum, U. S. 
P. ; Hgl. It is a bright-yellow amorphous powder, tasteless and 
odorless. It is insoluble in alcohol, water, and ether. Average 
dose, V 5 grain (0.01 Gm.). 

Ammoniated Mercury; Hydrargyrum Ammoniatum, U. S. P.; 
B. P. ; HgNH 2 Cl ; White Precipitate. It is a white amorphous 
powder, without odor and with an earthy, metallic taste. It is 
almost insoluble in water and alcohol. 
* s 

Bismuth Subnitrate; Bismuthi Subnitras, U. S. P., B. P. 

White bismuth, magisterium bismuthi ; sous-azotate de bismuth, 
F. ; Wismutsubnitrat, G. 

Source and Character. — It is a white heavy powder, consist- 
ing of a mixture of bismuth oxid, nitrate, and hydrate, and con- 
taining about 80 percent of pure bismuth oxid. It is odorless and 



ANTISEPTICS. 91 

almost tasteless, insoluble in water or alcohol, but soluble in nitric 
and hydrochloric acid. It is incompatible with potassium iodid, 
calomel, salicylic acid, tannic acid, and sulphur. 

Average Dose. — 7y 2 grains (0.5 Gm.). 

Medical Properties.— Astringent, mildly antiseptic, and pro- 
tective. 

Therapeutics. — Bismuth subnitrate is principally used as an 
internal astringent in diseases of the gastro-intestinal canal and as 
a dusting powder on wound surfaces. For the latter purpose it is 
useful, as it readily diminishes the secretions of the wound. A 
number of fatal poisonings have been recorded lately in which 
bismuth subnitrate was used in large quantities as dusting powder 
or in the form of Beck's bone paste. (See Plugging of Bone 
Cavities.) Bismuth poisoning manifests itself in the mouth by 
a distinct bluish-black line about the gum margin, salivation, and 
swelling of the gums and tongue. Gangrene of the soft palate 1 
has also been observed. 

Bismuth subnitrate is used in the form of an unctuous injec- 
tion (bismuth subnitrate, 10 parts; oil of cotton seed or oil of 
sesame, 15 parts; spermaceti, 30 parts) in radioscopy. The lique- 
fied material is injected into the cavity, and the x-ray picture shows 
a deep-black shadow which distinctly outlines the normal or patho- 
logic cavity, sinus, etc. To avoid poisoning with this bismuth 
paste, Lewin has recently advocated, as a substitute for bismuth, 
magnetic iron oxid or red ferric oxid (crocus, Paris red). 

Xeroform; Bismuth Tribromphenolate; C 6 H 3 4 Br 3 Bi 2 . It is 
a fine yellow powder, nearly odorless and tasteless, insoluble 
in water and alcohol, but partially soluble in weak hydrochloric 
acid. It is a nonirritating and nontoxic astringent, and has been 
recommended as a substitute for iodoform. For some time past 
it was much lauded as a component of a root filling material com- 
posed of 1 part of xeroform, 2 parts of zinc oxid, and sufficient 
eugenol to make a stiff paste. Quite a number of other bismuth 
compounds — bismuth subcarbonate, bismuth subgallate (derma- 
tol), bismuth subsalicylate, etc. — are official, but they are of minor 
importance to the dental practitioner; they are principally em- 
ployed as weak antiseptics intended for the gastro-intestinal canal 



92 PHARMACO-THERAPEUTICS. 

As previously stated (see Salts of the Heavy Metals), all salts 
of the heavy metals are antiseptics, and many of these salts are 
also powerful astringents. Certain metallic salts — the silver, cop- 
per, and zinc salts — are superseded in their antiseptic action by 
their astringent qualities, and are principally employed for this 
purpose in dental medicine. Consequently we have preferred to 
classify these metallic salts under the general heading of astrin- 
gents. 

The Acids, the Alkalies, the Halogens and their 

Derivatives. 

THE ACIDS. 

All inorganic and most organic acids possess more or less anti- 
septic action. Many of the acids act as astringents when applied 
in a weak solution, and as caustics when used in a pure state. All 
inorganic acids, with the exception of phosphoric acid, the chlorin 
substituting fatty acids, and many of the aromatic acids, provided 
they are readily soluble in water, act as precipitants of albumin. 
The inorganic acids, with the exception of boric acid, can not be 
used as antiseptics in the oral cavity, as they attack more or less 
readily the calcium salts of the tooth structure. The mineral 
acids are frequently administered in diluted form as antiseptics in 
disturbances of the gastro-intestinal canal ; they should always be 
taken through a glass tube, to protect the teeth. 

Many of the organic acids are classified as aromatic compounds 
and others as caustics, and consequently they are discussed under 
their respective headings. (See Antiseptics of the Aromatic 
Series, and Caustics.) 

* Boric Acid; Acidum Boricu*i,\U. S. P., B. P.; H 3 B0 3 ; Boracic 
Acid; Acide Borique, F. ; Borsaure, G. 

Source and Character. — It is usually prepared from native 
borax (sodium borate). It is a light, white, very fine powder, 
unctuous to the touch, or translucent, colorless scales, odorless, and 
having a faintly bitter taste. It is soluble in 18 parts of water, 



ANTISEPTICS. 93 

15 parts of alcohol, 5 parts of glycerin, and readily soluble in boil- 
ing water. 

Avebage Dose. — 7y 2 grains (0.5 Gm.). 
Medical Properties. — Antiseptic and astringent. 
Therapeutics. — Boric acid is a mild, nonirritating antiseptic 
and slight astringent; it is the only mineral acid which does not 
affect tooth structure. In the form of a dusting powder, as e 
glycerite or an ointment, and in saturated aqueous solutions, it is 
widely used as an external and, occasionally, internal antiseptic-. 
Ii is apparently more active on molds and fission fungi than on 
pathogenic bacteria. In the form of Thiersch's solution it is 
of service in washing out the antrum or other body cavities. On 
account of its very mild acidity it is largely used as the principal 
component of many proprietary mouth washes. As a dusting- 
powder on large wound surfaces, boric acid must be used with 
caution, to prevent too rapid absorption. A few cases of poison- 
ing, of which two have ended fatally, have resulted from the top 
liberal use of this antiseptic. Boric acid is sometimes added to 
foods as a preservative, which has given rise to heated discussions 
in regard to its deleterious effects on the health of the consumer. 
Its use for such purposes is prohibited in the United States. 

Glycerite of B or o glycerin; Glyceritum Boroglycerini, U. S. P.: 
Glyceritum Acidi Borici, B. P. It is a compound formed by 
' heating boric acid in glycerin, which is then dissolved in glycerin. 
It contains 31 percent of boric acid. 

Ointment of Boric Acid; Unguentum Acidi Borici, U. S. P., 
B. P. A paraffin ointment containing 10 percent of boric acid. 

Antiseptic Solution; Liquor Antisepticus, U. S. P. It contains 
2 percent boric acid, 1 percent benzoic acid, 1 percent thymol, and 
is flavored with eucalyptol and the oils of peppermint, winter- 
green, and thyme. This solution is apparently intended to re- 
place the many proprietary compounds of a similar nature. If 
this is true, it is a poor substitute. Its taste is most disagreeable, 
and its combination is not in accordance with modern concep- 
tions of an antiseptic solution. Strictly speaking, liquor anti- 
septicus is a toilet preparation and has no place in the pharma- 
copeia. 



94 PHARMACO-THERAPEUTICS. 

Hydrochloric Acid; Acidum Hydrochloricum, U. S. P.; HC1; 
Muriatic Acid ; Acide Chloriiydrique, F. ; Salzsaure, G. 

It contains 31 percent by weight of absolute hydrochloric acid. 
It is a colorless, fuming liquid of a pungent odor and an intensely 
acid taste, and should be kept in glass-stoppered bottles. 

•' Hydrochloric Acid, Diluted; Acidum Hydrochloricum 

Dilutum, U. S. P., B. P. 

It contains 10 percent (15.58 percent, B. P.) of absolute hydro- 
chloric acid. 

Average Dose. — 15 minims (1 Cc), well diluted. 



Nitric Acid; Acidum Nitricum, U. S. P., B. P.; HNO 



3 > 



Acide Azotique, F. ; Salpetersaure, G. 

It is a colorless, fuming liquid, of a very corrosive and caustic 
nature, having a suffocating odor. It stains the skin and the 
tissues a bright yellow, and is used as a very powerful caustic by 
placing a drop of the acid with a glass rod on the tissue to be 
destroyed. It contains 68 per cent (70 percent, B. P.) by weight 
of absolute nitric acid. It should be kept in glass-stoppered 
bottles. 

Nitric Acid, Diluted ; Acidum Nitricum Dilutum, 

U. S. P., B. P. 

It contains 10 percent (17.44 percent, B. P.) by weight of 
absolute nitric acid. 

Average Dose. — 30 minims (2 Cc), well diluted. 

NlTROHYDROCHLORIC AdD ; AdDUM NlTROHYDROCHLORICUM, 

U. S. P. ; Aqua Regia ; Eau Regale, F. ; Konigswasser, G. 

It is formed by mixing 180 parts of nitric acid with 820 parts of 
hydrochloric acid. It has been suggested to use this mixture as a 
substitute for sulphuric acid in the opening of root canals, accord- 
ing to Callahan's suggestion. Aqua regia is a very dangerous 
compound to use in the mouth, and has no advantage over sul- 
phuric acid for the above purposes. 



ANTISEPTICS. 95 

NlTROHYDROCHLORIC AdD, DILUTED ; AdDUM NlTROHYDRO- 
CHLORICUM DlLUTUM, U. S. P., B. P. 

It is formed by mixing 40 parts of nitric acid with 180 parts of 
hydrochloric acid, and with enough water to make 1,000 parts 
(6 parts nitric acid, 8 parts hydrochloric acid, and 50 parts dis- 
tilled water, B. P.). 

Average Dose. — 15 minims (1 Cc). 

Sulphuric Acid; Acidum Sulphuricum, U. S. P., B. P.; 
H 2 S0 4 ; Oil of Vitriol; Acide Sulphurique, F. ; Schwe- 

FELSAURE, G. 

It is a colorless, oily liquid, containing 92.5 percent (98 per- 
cent, B. P.) by weight of absolute sulphuric acid. It is very 
caustic and corrosive, often causing charring of the tissues and 
leaving a coal-black slough. It should be kept in well-stoppered 
bottles. Sulphuric acid in 50-percent solution has been recom- 
mended by Callahan 1 as a means of opening and enlarging ob- 
structed root canals ; it is very useful for such purposes. The acid 
may be carried to the root canal with a platinum probe or on a 
few fibers of asbestos wrapped about the probe. It is well to re- 
member that in diluting pure sulphuric acid the acid must be 
added in a thin stream to the water with constant stirring, to 
avoid spluttering and overheating of the mixture. 

Sulphuric Acid, Diluted; Acidum Sulphuricum Dilutum, 

U. S. P., B. P. 

It contains 10 percent (13.65 percent, B. P.) of absolute sul- 
phuric acid. 

Average Dose. — 30 minims (2 Cc), well diluted. 

Sulphuric Acid, Aromatic ; Acidum Sulphuricum Aromati- 
cum ; U. S. P., B. P.; Elixir of Vitriol; Elixir Vitrio- 
lique, P. ; Aromatische Schwefelsaure, G. 

It is an alcoholic solution, flavored with ginger and cinnamon, 
containing 20 percent (8 percent, B. P.) of absolute sulphuric 



1 Callahan: Proceedings Ohio State Dental Society, 1894. 



96 PHARMACO-THERAPEUTICS. 

acid, partly in the form of ethyl-sulphuric acid. It is employed 
as a caustic, styptic, and antiseptic, and is much lauded in the 
treatment of bone diseases. Since the introduction of phenol- 
sulphonic acid it has been largely superseded by the latter com- 
pound. 

Average Dose. — 15 minims (1 Cc.) ; well diluted. 

Phenolsulfonic Acid; Acidum Phenolsulfonicum; CeHeSCh; 
Sulfocarbolic Acid; Sulfophenol; Acide Phenolsulphon- 
ique, F.; Phenolschwefelsaure, G. 

Source and Character. — When phenol is treated with sulfuric 
acid, an acid radical is substituted for an H in the C 6 H 5 OH of the 
phenol, and a new compound is formed which is known as phenol- 
sulfonic or sulfo-carbolic acid. Depending upon the mode of pro- 
cedure, theoretically three types of phenol-sulfonic acid may be 
obtained — the ortho, the meta, and the para acid. By treating 
phenol directly with sulfuric acid, only the ortho or the para acid 
is formed, while the production of the meta acid requires a more 
complicated procedure. The ortho acid is formed when phenol 
and sulfuric acid are brought together at a low temperature, while 
by subjecting this same mixture to prolonged heating the pure 
para acid is formed. The various acids thus obtained always 
contain a variable small amount of free sulfuric acid. 

For practical purposes, the ortho-phenol-sulfonic acid may be prepared 
in the following way: 102 grams of sulfuric acid (96 per cent) are 
weighed out in a porcelain capsule, and 94 grams of pure phenol, previ- 
ously liquefied by gentle heat, are gradually added under constant stir- 
ring with a glass rod. The mixture must be kept at as low a tempera- 
ture as possible to avoid the formation of the para acid. The acid is 
set aside for a few days, after which time the reaction is practically com- 
pleted. A small amount of para acid is usually formed along with the 
ortho acid. To produce the para-phenol-sulfonic acid, the two acids are 
mixed in the same proportion and are kept at a temperature of about 
100° C. for a few hours, after which time the almost pure para acid has 
formed. Commercially, a 33 1-3 per cent solution of ortho-phenol-sulfonic 
acid in water is known as aseptol; this solution is also referred to as 
socolic acid. 

Phenolsulfonic acid (the ortho or the para acid) is a syrupy, yellowish 
liquid, becoming darker with age and having a pronounced acid reac- 
tion. It is readily soluble in water, alcohol, and glycerin, but insoluble 
in ether, chloroform, and some oils. It is practically odorless, or only 
feebly so, resembling phenol. It should be kept in glass-stoppered bot- 
tles, protected from light. 

Medical Properties. — Antiseptic and caustic. 

Therapeutics. — Phenolsulfonic acid was introduced into chem- 
istry some forty years ago by Laplace and Kekule, and since that 
time Annesen, Fraenkel, Vigier, Serrant, Hueppe, Schneider, and 



ANTISEPTICS. 97 

other? have worked out its therapeutic value. It was soon found, 
however, that it possessed no demonstrable advantage over sulfuric 
acid, hence it was quickly discarded by the medical profession. 
Dentistry owes its reintroduction principally to Buckley, Cook and 
MaWhinney. When phenolsulfonic acid is applied in weak aque- 
ous solutions it acts primarily as an antiseptic; in concentrated 
form it is a caustic. Solutions in alcohol or glycerin largely 
nullify these effects. 

The action of phenolsulfonic acid may be defined as being antiseptic in 
a weak solution and caustic when applied in a concentrated solution. In- 
cidentally it acts as an astringent on account of its sulfuric acid content. 
From the very nature of the composition of phenolsulfonic acid, its pri- 
mary action on living soft tissue manifests itself as a protoplasm poison, 
i. e., it precipitates the proteins, forming an eschar which is ultimately 
cast off. When brought into contact with bone or tooth structures its 
action depends largely upon the nature of its composition. The ortho 
acid acts purely as a rapid decalcifier, leaving the swelled organic matrix 
of the bone or tooth substance intact, while the para acid acts somewhat 
like sulfuric acid, i. e., it destroys the structures in toto. only to a much 
milder degree. Sulfuric acid acts principally as a caustic. It precipitates 
the proteins of the soft tissues, forming a white eschar which ultimately 
becomes black by carbonization. W T hen brought in contact with bone or 
tooth structure it kills the organic content, removes the water present, 
breaks up the organic material by forming water from the liberated oxy- 
gen and hydrogen, leaving ultimately nothing but carbon. The calcium 
salts are simultaneously dissolved and removed with the organic matrix. 
Its action is much more rapid on dead bone or tooth structure. In regard 
to the antiseptic action of phenolsulfonic acid, the experimental work of 
Hueppe, Vigier, Serrant, Schneider, and others has clearly demonstrated 
the important fact that of the three types of phenolsulfonic acid, the ortho 
acid is the most active, and the para acid is the weakest, while the meta 
acid stands intermediate between the two. According to Schneider, the 
ortho-phenol-sulfonic acid is three times as effective as the para acid. A 
one per cent solution of ortho-phenol-sulfonic acid is. equal in its anti- 
septic power to a 1 per cent solution of phenol, while, consequently a 1 
per cent solution of para acid is approximately three times less effective. 1 

Phosphoric Acid: Acidum Phosphoricum, U. S. P.; Acidum 
Phosphoricum Coxcextratum, B. P.; H 3 P0 4 ; Acide Phos- 
phorique, F. ; Phosphorsaure, G. 

It is a colorless liquid, of syrupy consistency, containing 85 
percent (66.3 percent, B. P.) by weight of absolute orthophos- 
phoric acid. It is colorless and has a strongly acid taste. It 
should be kept in glass-stoppered bottles. 

In commerce three kinds of phosphoric acid are mot : 

Orthophosphoric acid, H 3 P0 4 . 

Metaphosphoric acid, HP0 3 (glacial phosphoric acid). 

Pyrophosphoric acid, H 4 P,0 7 (white, hygroscopic, glassy 
masses) . 

1 Prinz: Dental Cosmos, 1912, p. 397. 



98 PHARMACO-THERAPEUTICS. 

Metaphosphoric acid is used as a component of the so-called 

oxyphosphate of zinc dental cements. A satisfactory acid for 

dental cement powders may be prepared as follows: 1 ounce 

(30 Gm.) pure zinc phosphate, 20 ounces (600 Gm.) glacial 

phosphoric acid in sticks, and 10 ounces (300 Gm.) distilled 

water, all quantities by weight, are placed in a glass-stoppered 

bottle, and set aside in a moderately warm place and occasionally 

shaken until the solution is completed. The acid is then filtered 

through a cone of glass wool placed tightly into the neck of a 

glass funnel. The first portions of the filtrate are returned to the 

funnel until the solution runs off perfectly clear. The acid is 

immediately transferred to small dry glass bottles and tightly 

corked. If the cement, when mixed with this acid, hardens too 

quickly, the latter may be slightly concentrated on a sand bath; 

if the cement sets too slowly, a very small quantity of distilled 

water should be added to the acid. Occasionally it will be found 

that the last part of the acid gives poor results in mixing the 

cement ; it is then best to discard the fluid instead of trying to 

remedy the evil. 

Phosphoric Acid, Diluted; Acidum Piiosphoricum Dilutum, 

U. S. P., B. P. 

It contains 10 percent (13.8 percent, B. P.) by weight of ortho- 
phosphoric acid. 

Average Dose. — 30 minims (2 Cc.) well diluted. 

THE ALKALIES. 

The antiseptic action of the alkalies depends principally on 
their power of disorganizing albumin by dissolution. They are 
therefore, closely related to the caustics. The alkali salts which 
liberate oxygen or halogens during their dissociation — sodium 
dioxid, sodium fluorid, etc. — act principally through their nega- 
tive ions. The hydrates of the alkalies are the strongest and the 
carbonate are the weakest antiseptics of this group. The soaps 
(alkaline oleates) are weak antiseptics; they act principally as 
detergents by virtue of their solvent power on fats, etc. f Soaps 
are often combined with specific antiseptics ( f ormaldehyd, phenol, 
tar, etc.), and then they become important therapeutic agents in. 
dermatology. Liquid soap, containing alcohol with the addition 
of an active antiseptic, is a valuable hand disinfectant; it is to be 
preferred for the operating room over the ordinary cake soap. 



% 



ANTISEPTICS. 99 

Lime, in the form of freshly slacked lime, or milk of lime, is a 
powerful disinfectant for excreta, provided it is used in at least 
20-percent solutions. Its action is decidedly more powerful when 
combined with chlorin (chlorinated lime). Sodium and potas- 
sium bicarbonate can not be classed as antiseptics ; sodium chlorid, 
in a 1-percent solution (physiologic salt solution), heated to body 
temperature, may be used as a temporary mouth wash when an 
absolute, neutral, mild antiseptic lotion is required. Ammonia 
is a weak antiseptic; its powerful irritating properties (see Irri- 
tants and Counterirritants) prohibits its use for antiseptic pur- 
poses. The hydroxids of potassium and sodium are powerful 
caustics ; they are occasionally employed as antiseptics in the treat- 
ment of gangrene of the pulp. (See Decomposition 01 the Tooth 
Pulp and its Treatment.) 

Sodium Borate; Sodii Boras, U. S. P.; Borax, B. P.; 
Na 2 B 4 O 7 +10H 2 O; Borax, F., G. 

Souece and Character. — It forms colorless crystals or a white 
powder, odorless, and having a sweetish, alkaline taste. It is sol- 
uble in 20 parts of water, very soluble in glycerin, but insoluble in 
alcohol. To a nonluminous flame it imparts an intense yellow color. 

Average Dose. — 7y 2 grains (0.5 Gm.). 

Therapeutics. — Sodium borate is a mild antiseptic, and is 
freely employed in diseases of the mucous membranes. It is an 
important component of the widely used Dobell's solution. Com- 
bined with solutions of formaldehyd, it is found to be very service- 
able for the sterilization and preservation of metallic instruments, 

Dobell's Solution (N. F.). 

Sodium borate 15 parts. Phenol, liquid 3 parts. 

Sodium bicarbonate 15 parts. Glycerin 30 parts. 

Water enough to make 1,000 parts. 

Soap; Sapo, U. S. P.; Sapo Duras, B. P.; Hard Soap; Castile 

Soap; Savon, F. ; Seipe, G. 

It is prepared from sodium hydroxid and olive oil. 

Soft Soap; Sapo Mollis, U. S. P., B. P.; Green Soap. It is 
a soft, unctuous, brownish-green soap made from potassium 
hydroxid, linseed oil, and alcohol. 

Curd Soap; Sapo Animalis, B. P. It is a hard soap made from 
sodium hydroxid and some purified animal fat containing chiefly 
stearin. 

A very serviceable liquid soap for the operating room, which 



100 PHARMACO-THERAPEUTICS. 

may be readily made in larger quantities on an economical basis, 
is, according to Wilbert's 1 formula, prepared as follows : 

Sodium hydrate 40 parts. 

Potassium hydrate 250 parts. 

Cottonseed oil 500 parts. 

Alcohol 250 parts. 

Distilled water enough to make 2,500 parts. 

In a suitable container, preferably a glass-stoppered bottle, 
dissolve the sodium hydrate and the potassium hydrate in 250 
parts of distilled water, add the alcohol, and then add the cot- 
tonseed oil in 3 or 4 portions, shaking vigorously after each 
addition. Continue to agitate the mixture occasionally until 
saponification has been completed; then add the remaining por- 
tion of distilled water and mix. The only precautions that are 
at all necessary is to use U. S. P. grade of ingredients, and to 
be sure that saponification is complete before adding the re- 
maining portion of the distilled water. 

The addition of 2-percent solution of formaldehyd increases 
the antiseptic effect of this liquid soap very markedly. Liquid 




Figure 7. 
Liquid Soap Dispenser. 



soap dispenses are at present available in the market, which 
materially facilitate the ready use of this toilet necessity. 



1 Wilbert: American Druggist, 1908, p. 139. 



ANTISEPTICS. 101 

THE HALOGENS AND THEIR DERIVATIVES. 

The antiseptic value of the halogens — bromin, chlorin, fluorin, 
and iodin — depends on the chemic reaction which ensues when 
they are brought in contact with albumin ; they substitute their 
own atoms for the hydrogen atoms of the albumin molecule and 
thereby destroy the latter. Incidentally, halogen acids are formed 
which act as precipitants of albumin. The halogens are rarely 
used as antiseptics or disinfectants in solid form or as gases; 
they act only in the presence of moisture. In aqueous solution 
they are powerful disinfectants, and are used as such, especially 
chlorin, on a large scale. Bromin or its compounds and fluorin 
are not employed as antiseptics. Sodium fluorid possesses power- 
ful antiseptic properties ; its use has been suggested as an addition 
to tooth powders (see Preparations for the Mouth and Teeth), 
and it is largely employed in the industries for checking fermenta- 
tion in manufacturing yeast, in distilleries, breweries, etc. Head 
has recently introduced an ammonium bifluorid as a "tartar 
solvent." (See Uric Acid Solvents.) Chlorin in the form of 
chlorinated lime has found a wide field of application as a disin- 
fectant for dejecta, bedding, etc., and incidentally as a bleaching 
agent. (See Bleaching Agents.) Iodin in compound aqueous so- 
lutions and as iodin trichlorid possesses powerful antiseptic prop- 
erties; at one time the latter compound was recommended as an 
antiseptic for root canal treatment, but it has never come into 
general use. Tincture of iodin applied as an antiseptic has be- 
come quite prominent within the last few years. Surgeons are 
utilizing the powerful antiseptic properties of iodin in alcoholic 
solution with marked success as a means of asepticizing the skin 
prior to an incision. The technique is very simple. The field of 
operation is cleansed in the ordinary way with hot water and 
soap, and the tincture of iodin is painted over the surface within 
the region of the incision in the form of a broad band. The 
iodin solution keeps the bacteria and their germs fixed to the 
surface during the operation. The application of this method for 
operations in the mouth deserves to be recommended. Aseptic 
wounds that heal by first intention often fail to give the clean 



102 PHARMACO-THERAPEUTICS. 

linear cicatrix aimed at by both surgeon and patient. After the 
sutures are removed, the margin of the incision often leaves 
small cuneiform fissures, which finally result in an irregular scar. 
To stimulate rapid cell proliferation, the slightly irritating prop- 
erty of tincture of iodin is useful. The action of its alcoholic 
component is responsible for the light form of hyperemia which, 
together with the iodin, influences the healing of the wound 
most markedly, and usually a clean, small scar results. The 
tincture should be applied once a day for four to five days follow- 
ing the removal of the stitches. Iodin achieved its greatest 
triumph through its many aromatic compounds, of which iodo- 
form is the typical representative. The various solutions of iodin 
are principally employed as irritants (see Irritants and Counter- 
irritants), while its salts are largely used as specifics in the third 
stage of syphilis and to favorably influence metabolism. (See 
Alteratives.) 

Iodoform ; Iodoformum, U. S. P., B. P. ; CHI 3 ; Triiodomethan ; 

I0D0F0RME, F. ; JoDOFORM, G. 

Source and Character.— It is usually obtained by the action 
of iodin on alcohol in the presence of an alkali or alkali carbo- 
nate. It is a fine lemon-yellow powder or small crystals, possess- 
ing a very persistent and penetrating odor and a disagreeable 
taste. It is practically insoluble in water, but soluble in about 50 
parts of alcohol, 6 parts of ether and fixed and volatile oils. It 
is incompatible with calomel, mercuric oxid, silver nitrate, tannin, 
and balsam of Peru. 

Average Dose. — 4 grains (0.25 Gm.). 

Medical Properties. — Antiseptic, alterative, and anesthetic. 

Therapeutics. — Iodoform is the wound antiseptic par excel- 
lence. It has many objections which materially limit its use in 
surgery. Iodoform, per se, does not possess antiseptic proper- 
ties, in spite of its high iodin component (96 percent) ; ordinarily 
it is not even sterile. . Its very penetrating and persistent odor, 
which invades everything with which it comes in contact, makes its 
use disagreeable to patient and practitioner alike. Iodoform is 
easily decomposed ; when it is dissolved in alcohol, ether, or fatty 



ANTISEPTICS. 103 

oils, it readily liberates free iodin. The secretions of a purulent 
wound contain large quantities of fatty substances which dissolve 
iodoform, especially when air is excluded. Iodin in statu nascenti 
acts as a powerful antiseptic. Certain bacteria — tetanus, tubercle 
bacillus, etc. — produce iodin reducing substances ; they are, there- 
fore, readily destroyed by iodoform. The products of bacterial 
activity are oxidized by iodoform, and hence it acts as a deodorant. 
Its slightly irritating properties stimulate cell proliferation and 
reduce the migrating power of the leucocytes. On irritable skin it 
is liable to cause various exanthematous eruptions. When larger 
quantities of iodoform are quickly absorbed, they produce specific 
intoxication; as the iodoform action is better understood, intoxi- 
cations are rare at present. 

Iodoform is a sovereign remedy to keep clean, fresh wounds 
aseptic and to check wound secretions. In abscess cavities and on 
ulcerating surfaces, or in regions which are easily infected from 
their surroundings — the mouth — it acts as an extremely service- 
able prophylactic. It quickly clears up and deodorizes a foul 
wound; it is slightly anesthetic and favors granulation. 

The opinions regarding the use of iodoform in dentistry are 
divided. Some practitioners have lauded it very highly, espe- 
cially as an excellent antiseptic in the treatment of gangrenous 
pulps, while others condemn it absolutely. A wrong conception 
regarding its action is probably responsible for these diametrically 
opposed views. As a component of a devitalizing paste it has no 
place, and, since we have more powerful antiseptics for the treat- 
ment of gangrenous pulps, it may be readily dispensed with for 
such purposes. In the form of a 5 or 10-percent moist gauze it 
is superior to any other known iodin preparation for the dressing 
of foul ulcers, deep-seated pockets, purulent antra, certain disturb- 
ances arising from the difficult eruption of a lower third molar, 
etc. For the treatment of the purulent stages of pyorrhea, iodo- 
form as a paste or an emulsion is still employed by many practi- 
tioners. As a component of a permanent root filling it is favored 
by many, although it is difficult to understand what purpose it 
should serve in this connection. 

To overcome the disagreeable odor of iodoform, admixtures of 



"104 PHARMACO-THERAPEUTICS. 

cumarin (the odoriferous principle of the tonka bean), ground 
coffee beans, thymol, menthol, etc., have been suggested, but they 
possess very little practical value. Whenever the odor of iodoform 
is positively removed, its composition is chemically altered and its 
therapeutic action is largely destroyed. To overcome the many 
drawbacks of iodoform, chemists have endeavored to create iodin 
compounds which are free from these objections. So far no per- 
fect substitute has been produced, although a few of the more 
recent compounds answer the purpose fairly well. An early repre- 
sentative is iodol. It is apparently less readily decomposed than 
iodoform, and is little used at present. Aristol — thymol iodid — 
has been widely employed for some time ; it is very readily decom- 
posed, but its iodin component is materially less than that of iodo- 
form. Sozoiodolates of potassium, sodium, and zinc have been 
prepared; the latter salt has been quite extensively used in the 
past. Nosophen, antinosifi, and entoxin are trade names'' given 
to iodin compounds of phenol-phthalate, while europhen is a 
complex preparation of cresol and iodin. Again, iodin com- 
pounds of albumin have been created ; iodalbin and iodoformogen 
are examples of the more important representatives of this group. 
Recently a compound of iodin with quinolin as a base has been 
introduced as a substitute for iodoform under the name of viof orm \ 
from all appearances it seems to be at present quite a favorite 
with the surgeons. It is successfully employed in the mouth in 
all those conditions where iodoform is indicated. 

Iodol; Iodolum, U. S: P.; C 4 I 4 NH; Tetraiodopyrrol. 

It is a light grayish-brown powder, without odor or taste, in- 
soluble in water, but soluble in alcohol, chloroform, and ether. It 
contains about 89 percent of iodin. 

Average Dose. — 4 grains (0.25 Gm.). 

Thymol Iodid; Thymolis Iodidum, U. S. P.; C 20 H 24 O 2 I 2 ; 

DlTHYMOL-DlIODID ; ARISTOL. 

It is a light reddish-yellow bulky powder, with a slight aromatic 
odor, containing 45 percent of iodin. It is insoluble in water and 
glycerin, but readily soluble in alcohol, chloroform, ether, and 
volatile and fatty oils. In the form of an oily solution it is used 



ANTISEPTICS. 105 

as a substitute for the tincture of iodin or the solutions of iodin 
in fatty oils. (See Irritants and Counterirritants.) 

Europhen; Diiso butyl Cresol Iodid. It forms a yellow, volumi- 
nous powder, containing 28 percent of iodin and having a faint, 
saffron-like odor. It is insoluble in water and in glycerin, but 
readily soluble in alcohol, ether, chloroform, and volatile and 
fatty oils. It resembles thymol iodid very closely in its action. 

Vioform; Iodochloroxyquinolin; Nioform. It is a very volu- 
minous light-yellow powder, practically odorless, and insoluble in 
water, but slightly soluble in alcohol. It may be sterilized without 
decomposition. Vioform contains 41.57 percent of iodin. It is 
nontoxic and nonirritant, and it is claimed to be an ideal sub- 
stitute for iodoform. It deserves to be recommended for dental 
purposes. 

A compound known as loretin has recently been introduced as 
an iodoform substitute; it is closely related to vioform. 

Iodoform Emulsion. 

Iodoform 5 parts. 

Mucilage of gum arabic 2 1 /2 parts. 

Glycerin 8 parts. 

Water enough to make 30 parts. 

Iodoform Bone Plombe. 

Iodoform 10 parts. 

Oil of sesame .' 15 parts. 

Spermaceti 30 parts. 

(Mayrhofer.) 

Iodoform Paste. 

Iodoform powder is mixed with 5-percent phenol solution ; after 
24 hours the supernatant fluid is poured off, and the iodoform is 
mixed with lactic acid to a thick paste. This paste is used for 
the treatment of purulent pockets, etc., about the mouth. 

The odorless vioform may be substituted for iodoform in the 
above preparations, 



106 PHARMACO-THERAPEUTICS. 

Chlorinated Lime; Calx Chlorinada, U. S. P., B. P. Bleach- 
ing Powder ; Sous Chlorure de Chaux, F. ; Chlorkalk, G. 

Chlorinated lime is often improperly called chlorid of lime. It 
is a mixture of calcium hypochlorite, calcium chlorid, lime, and 
water, and it should contain not less than 35 percent of available 
chlorin. It is a white or grayish-white powder, with the odor of 
chlorin, and giving off chlorin gas in the air, especially in the 
presence of an acid. It is only partially soluble in water. Chlo- 
rinated lime is used in the preparation of the various chlorinated 
solutions, as a bleaching agent, and as a disinfectant on a large 
scale. For the latter purposes it is best employed in the form of 
milk of lime, with an excess of acid; it must be used liberally 
if complete success should be insured. As a deodorizer of the oral 
cavity in the form of a tooth powder it should not be used. 

Preparations. — 

Liquor Sodse Chlorinatx, U. S. P., B. P. ; Solution of Chlori- 
nated Soda. Labarraque's solution or eau de Javelle. It is a 
clear, pale green liquid, having an odor of chlorin and containing 
at least 2.6 percent (2.5 percent, B. P.) by weight of available 
chlorin. It readily bleaches vegetable colors, and was formerly 
largely used as a bleaching agent of discolored tooth structure. 

Liquor Calcis Chlorinatse, B. P. ; Solution of Chlorinated Lime. 
A solution of chlorinated lime, yielding about 3 percent of avail- 
able chlorin. 

Solutions Which Evolve Nascent Oxygen. 

Molecular oxygen, in its pure state or mixed with nitrogen and 
other gases in the form of air, does not manifest an inhibitory or 
destructive action on bacteria. For a long time chemists have 
been familiar with the powerful affinity of oxygen in its nascent 
state for other substances, which process is known as oxidation. 
Robin has experimentally shown that the therapeutic effect of a 
substance is greatly intensified if it is set free from its compound 
in the organism — if it is present in statu nascendi. This is espe- 
cially true of many cf the oxygen compounds. 

Nascent oxygen may be furnished by two kinds of autoxidizers — 



ANTISEPTICS. 107 

one direct source is its allotropic form known as ozone, and the 
other is represented by the many dioxids, chiefly hydrogen dioxid, 
and those of the alkali and alkaline earth metals. The nascent 
oxygen obtained from both sources is based on the same principle 
of formation : 

Ozone=0 — — 0, or 3 , is split up in 2 +0 (nascent state) . 

A dioxid, 1 X — — 0, or X0 2 , is split up in XO+0 (nascent 
state). 

According to Nernst, the formation and the association of ozone 
is illustrated by the following equation : 

03^02+0 

02^0+0 

Only one atom of the three atoms of the ozone molecule enters 
into active or atomic oxygen, the other two forming molecular or 
inactive oxygen. This very fact is true of the oxygen molecule 
of a dioxid — one atom is set free, while the other one remains 
combined with the metal in the form of an oxid. The ozone 
molecule and the dioxid molecule play the role of a single atom 
of oxygen in the reaction of oxidation. The amount of available 
oxygen in a dioxid depends on the degree of superoxidation of 
the original oxid. Comparative tests as to the efficacy of ' the 
action of nascent oxygen obtained from ozone and of nascent 
oxygen obtained from a dioxid have apparently never been made ; 
from their general chemic behavior we are justified to assume 
that it is the same. Ozone, as well as the dioxids, are endothermic 
compounds — that is, they require energy in the form of heat or 
electricity for their formation. They are comparatively easily 
decomposed, liberating again the same amount of energy in the 
form of heat which was absorbed in their formation. Ozone has, 
so far, been produced only as a gas, while the dioxids, with the 
exception of hydrogen dioxid, are solids. Oxygen obtained from 
ozone is usually produced by electric energy at the place of its 
consumption ; it is an unstable gas, which, for practical purposes, 
can not well be stored. ^ The dioxids are usually fairly stable com- 
pounds; they furnish any fixed amount of oxygen, if so desired, 



1 X represents any metal combined with two atoms of oxygen into a dioxid. 







108 PHARMACO-THERAPEUTICS. 

at any moment, and are, in reality, transportable accumulators of 
available oxygen. 

Atomic oxygen — oxygen in its nascent state — has a free valency ; 
it can not remain in that state, but energetically seeks to combine 
with organic matter. This powerful affinity for every oxidizable 
substance, including albumin, is known as oxidation, or, when 
accompanied by heat and light, as combustion. The antiseptic 
action of the oxygen carrying metals depends on this fact. The 
negative nascent oxygen which is set free during ionization of 
the metallic dioxids is very little irritating to the soft tissue, while 
certain of the positive metallic ions act as caustics ; this factor pro- 
hibits their use as wound antiseptics — sodium dioxid. 

In the industries the powerful oxidation of albuminous sub- 
stances by electric ozonization is made use of in the purification of 
drinking water. Ozonizing plants are now in practical use in sev- 
eral large European cities and in the United States. It is claimed 
that 15 to 135 grains (1 to 9 Gm.) of ozone are sufficient for the 
sterilization of 24,025 cubic inches (1 cubic meter) of polluted 
water. 

Of the many dioxids, hydrogen dioxid, the dioxids of calcium, 
magnesium, and zinc, and the perborate of sodium and, indirectly, 
oxone, are medicinally employed. Recently some organic dioxids 
— succinic dioxid known as alphozon, and the benzoyl-acetyl 
dioxid known as acetozon — have been introduced as antiseptics for 
internal and external purposes. Aside from its action as an anti- 
septic and sterilizing agent, nascent oxygen is employed as a 
bleacher of discolored teeth, and as an oxidizing or reducing agent 
in certain metallurgical processes in the dental laboratory. Gen- 
eral medicine has made use of pure oxygen in the treatment of 
pulmonary diseases and as a restorative agent in accidents from 
general anesthesia or in poisoning with other gases. 

Solution of Hydrogen Dioxid; Aqua Hydrogenii Dioxidi, 
U. S. P. ; Liquor Hydrogenii Peroxidi, B. P. 

Synonyms. — Solution of hydrogen peroxid, pyrozon; solution 
de peroxide d'hydrogen, eau oxygenee, F. ; Wasserstoffsuper- 
oxydlosung, Perhydrol, G. 



ANTISEPTICS. 109 

Source and Character.— Hydrogen dioxid was discovered by 
Thenard in 1818, and was then known as oxygenated water. It 
was not used to any extent until Richardson, in 1860, introduced 
it into medicine. It is often found in small quantities in the 
atmosphere after heavy storms, or in any other process in which 
ozone is formed in the presence of water. Whenever solutions of 
certain dioxids — sodium dioxid or barium dioxid — are treated 
with diluted acids, it is readily formed according to the following 
equation : 

Ba0 2 +H 2 S0 4 =2HA+BaS0 4 . 

For manufacturing purposes, usually barium dioxid is decom- 
posed in the presence of sulphuric or phosphoric acid; the acids 
form an insoluble compound with the barium. For dental pur- 
poses an alkaline solution of hydrogen dioxid of various strengths 
may be extemporaneously prepared by dissolving sodium diborate 
in water. Absolute hydrogen dioxid (about 99 percent pure) is a 
thick, oily colorless liquid, specific gravity 105, which does not con- 
geal at —22° F. (—30° C). When brought in contact with cer- 
tain metals — gold, silver, platinum, etc. — or when exposed to sun- 
light or heat, it readily decomposes, often with explosive violence. 
The official preparation is a slightly acidulous aqueous solution of 
hydrogen dioxid, containing, when freshly prepared, about 3 per- 
cent by weight of the pure H 2 2 , which corresponds to about 
10 percent by volume of available oxygen. It has a specific gravity 
of 1.006 to 1.007. Its solutions are preferably stored in amber- 
colored bottles, away from light and sudden changes of tempera- 
ture. It will gradually diminish in strength, and age, heat, and 
protracted agitation decompose it prematurely in water and oxy- 
gen. To preserve hydrogen dioxid solution, tannic acid and 
acetanilid in small quantities have been suggested. Of the former, 
about 1:6,000 and of the latter about 1:2,000 are necessary. Al- 
most all of the present commercial hydrogen dioxid solutions con- 
tain small quantities of acetanilid as a preservative. The ordi- 
nary 3-percent solution may be concentrated by carefully heating 
it to a temperature not over 140° F. (60° C.) on a water bath. 
It loses chiefly water, but, when rapidly heated, it is apt to explode. 
It is incompatible with alkalies, albumin, ammonia, arsenous salts, 



110 



PHARMACO-THERAPEUTICS. 



Q 



phenol, chlorids, ferric salts, iodids, lime water, mercurous salts, 
nitrates, permanganates, sulphates, tartrates, and with most tinc- 
tures. 

Aside from the ordinary 3-percent solution of hydrogen dioxid, 
higher concentrated solutions are found on the mar- 
ket. A 25-percent solution of hydrogen dioxid in 
ether is known as caustic pyrozon, and a 30-percent 
solution in water is known as perhydrol. Caustic 
pyrozon is put up in glass tubes containing a few 
cubic centimeters, while perhydrol is marketed in 
paraffin-lined bottles of various sizes. In opening a 
pyrozon tube great care should be exercised to pre- 
vent explosion by placing the tube in cold water 
and wrapping it in a wet towel before the end is 
broken off. Its contents must be transferred at once 
to a glass-stoppered bottle, provided with a ground 
cap, to prevent evaporation of the ether. Perhydrol 
solution is to be greatly preferred whenever a highly 
concentrated solution of hydrogen dioxid is desired. 
It is a chemically pure solution of H 2 2 in distilled 
water, furnishing about 30 percent by weight or 100 
percent by volume of available oxygen. It is abso- 
lutely free from acid, and may be diluted with water 
or alcohol to any desired strength. Solutions should 
preferably be made fresh when needed. If carefully 
preserved in the original container and stored in a 
cool place, perhydrol will retain its oxygen for some 
time. 

A simple test for hydrogen dioxid is made as 
follows: Mix 10 cubic centimeters of distilled water 
with 10 drops of diluted sulphuric acid, 1 drop of 
potassium chromate test solution (1 part potassium 
chromate dissolved in sufficient water to make 100 
cubic centimeters) , and 2 cubic centimeters of ether. 
On the addition of the solution containing hydrogen 
dioxid, a blue color will appear at the line of contact 
which will, after shaking, separate with the ethereal layer. 







Figure 8. 

Minim Syringe 

for Applying 

H 2 2 Solutions. 



ANTISEPTICS. 



Ill 



Average Dose. — 1 fluidram (4 Cc). 

Therapeutics. — The ideal external antiseptic for the body 

the skin, external mucous membranes, and wound surfaces is a 

substance which destroys the bacteria and their products, but 
which will not harm the tissues of the host. Hydrogen dioxid 
approaches this ideal more closely than any other known anti- 
septic. When brought in contact with bacteria and their prod- 
ucts, it acts as a powerful antiseptic and deodorant : it is not 
absorbed by the tissues, but by its reaction with the living cell it 
is split up in oxygen and water. According to Heinz 1 its action 
on staphylococcus pyogenes aureus and bacillus pyocyaneus is 
recorded as follows : 



SOLUTION OF HYDROGEN DIOXID. 





Staphylococcus pyogenes aureus 


Bacillus pyocyaneus 


Concentration 


After 
24 hours 


After 
48 hours 


After 
72 hours 


After 
24 hours 


After 
48 hours 


After 
72 hours 


1 percent 

0.75 percent .... 
0.5 percent .... 

0.25 percent 

0. 1 percent .... 


+ 1 1 1 1 


+ 





1 M 1 1 


+ + 1 1 1 


+ + 1 1 1 



When hydrogen dioxid is brought in contact with blood, pus, 
serum, wound exudates, etc., it produces a heavy froth, inci- 
dentally destroying the bacteria chemically and cleansing the 
wound surfaces mechanically. It acts as a strong deodorant by 
oxidizing the odorous gases arising from putrefactive processes. 
It should not be injected into pus cavities unless free drainage 
is established, as otherwise the free liberation of oxygen will 
force the infection into deeper structures. The same principle 
holds good in treating disturbances of the antrum of Highmore. 
To remove any obstructions, it should always be preceded in such 
cases by copious injections of physiologic salt solution heated to 
body temperature. On fresh granulating surfaces it should not 
be employed, as it tends to break down this new delicate tissue 
growth. In the various forms of stomatitis, and as a prophy- 



1 Heinz: Handbuch der Experimentellen Pathologie und Pharmakologie, 1904. 



112 



PHARMACO-THERAPEUTICS. 



lactic in mercurial administration in syphilis, it deserves to be 
highly recommended, and especially when combined with a metal- 
lic astringent and some of the more persistent antiseptics. H 2 2 
solutions possess distinct styptic properties; they should not be 
used for such purposes in root canals, as their action on the 
hemoglobin of the blood may cause a discoloration of the tooth 
structure. Strong solutions of H 2 2 (pyrozon, perhydrol) are 
powerful caustics, and they are used as such for the destruction 
of gum tissue, in fistulous tracts, in pockets of pyorrheal teeth, 
and as styptics in severe hemorrhage, iYndresen 1 advocates per- 
hydrol as the sovereign remedy in the treatment of hypersensi- 
tive dentin, especially in cervical cavities. It will not blacken 
the cavity like silver nitrate, which is usually employed for such 




Figure 9. 
Pyrozon Probe Cup. 



purposes, but instead whitens the tooth structure. The caustic 
solution requires careful handling, and the soft tissues have to be 
well protected by suitable napkins, a coating of vaselin, etc. 
Burns from caustic H 2 2 solutions are relieved by immediate 
washings with water and covering the burned surfaces with a 
mild ointment. In using these powerful solutions it is good 
practice to pour the necessary quantity into a watch crystal or 
into a "pyrozon probe cup," and then apply it with a suitable 
applicator, a platinum minim syringe, wooden probe, etc. Great 
care should be exercised to prevent the caustic solution from 
coming in contact with woolen fabrics, as it will char them, or 
even set them on fire. 



1 Andresen: Deutsche Monatsschrift fiir Zahnheilkunde, 1905, p. 25. 



ANTISEPTICS. 



113 



* 



Antiseptic Solutions. 

Hydrargyr. chlorid. gr. j (0.06 Gm.) 

Aquas hydrogen, dioxid. fl^ ij (60 Cc.) 

M. 

Sig. : Inject with a platinum pointed syringe into pus 
pockets in pyorrhea. 



£ 



Resorcinol 

Zinc, chlorid. 

Menthol. 

Thymol. 

Glycerin. 

Alcohol. 

Aquas hydrogen, dioxid. 



3 J (4Gm.) 
gr. x (0.65 Gm.) 
gr. xx (1.3 Gm.) 
gr. xv (1.0 Gm.) 
AS j (30 Cc.) 
fig ij (60 Cc.) 
ad fig viij (240 Cc.) 



M. 

Sig. : Teaspoonful in a tumblerful of warm water as a 
gargle in syphilis of the mouth. 

Oxygen; Oxygexum; 0; Oxygexe, F. ; Sauerstoff, G. 
Source and Character. — Oxygen may be prepared from 
heating at a low temperature a mixture of 5 parts of potassium 




Figure 10. 

Oxygen Inhalation Apparatus A cylinder of liquid oxygen connected with a wash bottle 
half filled with water, and rubber tubing, ready for use. 

chlorate and 1 part of manganese dioxid. It must be purified 
before storing by passing it through wash bottles containing 
alkali, and is dried by passing it through sulphuric acid. It 



114 



PHARMACO-THERAPEUTICS. 



may be liquefied by pressure, forming a bluish liquid, which 
can be readily stored in steel cylinders. In commerce these 
cylinders contain 40, 75, and 100 gallons respectively, and are 
painted red to differentiate them from the nitrous oxid cylinders, 
which are painted black. 

Pure oxygen is readily obtained by decomposing oxone, a 
solid, fused sodium dioxid. Oxone is neither combustible nor 
explosive; it may be stored in air-tight tin cans for any length 
of time, or may be transported without danger, and is always 
ready for use. When oxone is brought in contact with water 




Figure 11. 
Portable Oxone Generator. Closed. 



it instantaneously produces oxygen. Approximately one pound 
(453 Gm.) furnishes two cubic feet (60 liters) of pure oxygen, 
which corresponds to about 320 times its own weight. A very 
simple apparatus, the oxone generator, made by the Rossler & 
Hasslacher Company, of New York, is readily available for 
such purposes. One charge of the apparatus furnishes about 
fourteen to fifteen gallons of pure oxygen within a few moments' 
time. So far as known, it is the simplest method of obtaining 
pure oxygen for medicinal purposes and for the laboratory. The 
value of an oxone generator is readily appreciated by those who 
utilize pure oxygen in their practice. 



ANTISEPTICS. 



115 



Oxygen is a colorless, inodorous gas; 1 liter weighs 1.43 grams 
at 32° F. (0° C), and 100 volumes of water at 32° F. (0° C.) dis- 
solve 4.1 volume of oxygen. It combines readily with most ele- 
ments, forming oxids. This process is known as oxidation, and, 
when attended by great heat and light, as combustion. 

Therapeutics. — Oxygen is necessary to carry on life. In the 
form of air ( l / 5 of the atmosphere is oxygen, the remainder being 
nitrogen, with small proportions of carbon dioxid, etc.), it fur- 
nishes the means for oxidation of some of the waste products of 
the body. In plant life two processes, oxydase and catalase ; re- 




FlGURE 12. 

Portable Oxone Generator. Opened. 

spectively bind or furnish free oxygen. The latter is essential 
for the maintenance of the vegetable cell. In medicine pure oxy- 
gen gas is used by inhalation in pulmonary diseases and as a 
restorative agent in those conditions where the tissues have been 
imperfectly supplied with this gas — as in coal gas poisoning, 
anesthesia, etc. It is also used, in combination with nitrous oxicl, 
for anesthetic purposes to overcome cyanosis and to furnish 
enough oxygen with the anesthetic vapor to maintain life. 

Calcium Dioxid; Calcii Dioxidi; Ca0 2 ; Calcium Peroxid; 

BORITE. 

It is a light-yellow powder, odorless and tasteless, and contain- 
ing about 13 to 18 percent available oxygen. It is almost in- 



116 PHARMACO-THERAPEUTICS. 

soluble in water, but decomposes in the presence of moist organic 
matter, Weak acids readily decompose it into active oxygen and, 
usually, into insoluble calcium salts. Calcium dioxid has been 
advocated as a component of tooth powders for the purpose of 
liberating free oxygen in the mouth. It is not as well suited 
for this purpose as some of the other oxygen compounds. (See 
Preparations for the Mouth and Teeth.) As an internal remedy 
it is much lauded in acid dyspepsia and in summer diarrhea of 
children in 3 to 10-grain (0.2 to 0.6 Gm.) doses. Calcium dioxid 
is also largely used in the industries as a harmless preservative of 
foods, for aging beverages, as a preventive of seed diseases, etc. 

Zinc Dioxid; Zinci Dioxidi; Zn0 2 ; Zinc Peroxid; Zinc Per- 

HYDROL ; DERMOGEN. 

It is a superoxidized zinc oxid, containing about 50 to 55 per- 
cent of pure zinc dioxid, and averaging about 9 percent available 
oxygen. It is a yellowish-white powder, insoluble in water, but 
readily soluble in an acid medium. In the presence of moisture 
from a wound, moist skin surfaces, etc., it will slowly and con- 
tinuously liberate active oxygen; the remaining zinc oxid is a 
nonirritating astringent. Hence its greatest field of therapeutic 
application lies in the domain of the dermatologist. It is widely 
used in skin diseases as a dusting powder or in the form of oint- 
ments, and it is much lauded for the treatment of burns. When 
applied in the form of an ointment it should never be mixed with 
an animal fat, as it will decompose the latter, forming rancid 
(fatty acid) compounds with the ointment base, which would, 
of course, irritate the skin or wound surfaces. Liquid or solid 
petrolatum are the only permissible bases for such purposes. 

Ifc Zinc, dioxid. 5 J ( 4 -° Gm -) 

Petrolat. alb. 3 j (30.0 Gm.) 

M. f. ungt. 
Sig. : Ointment for burns. 

I£ Zinc, dioxid. 3 *j (8.0 Gm.) 

Acid, boric. 5 ss (15.0 Gm.) 

Talc, purine. ad % ij (60.0 Gm.) 

M. f. plv. 

Sig. : Dusting powder for wounds. 



ANTISEPTICS. 117 

Magnesium Dioxid; Magnesii Dioxidi; Mg0 2 ; Magnesium 
Peroxid; Magnesium Perhydrol; Biogen. 

It is a compound of magnesium dihydroxid and magnesium 
hydroxid, containing from 20 to 30 percent of pure magnesium 
dioxid and averaging about 7 to 8 percent available oxygen. 
It is a tasteless, white, amorphous powder, almost insoluble in 
water, but readily soluble in the presence of acid media. On 
account of its very mild alkalinity it is much lauded as a com- 
ponent of tooth powders (see Preparations for the Mouth and 
Teeth), and is freely administered internally in 4 to 8-grain (0.25 
to 0.5 Gm.) doses in rheumatism, diarrhea, intestinal diseases, 
etc. As a means of furnishing free oxygen to cell activity and 
thereby increasing metabolism, it is recommended, although the 
claims for such action have as yet not been substantiated. Under 
the name of biogen it has been widely advertised for such pur- 
poses. Magnesium dioxid can be safely employed as a harmless 
disinfectant for the sterilization of drinking water. 

Strontium Dioxid; Strontium Dioxidi; Sr0 2 ; Strontium 

Peroxid. 

It contains from 80 to 90 percent of pure strontium dioxid and 
furnishes about 12 percent available oxygen. It is a voluminous 
white powder, almost insoluble in water, but parts with its 
oxygen in the presence of acids. In its general behavior it re- 
sembles closely calcium dioxid, and is used more or less for the 
same purposes. 

Sodium Dioxid; Sodii Dioxidi; Na0 2 ; Sodium Peroxid. 

Sodium dioxid is a yellowish powder, which is readily soluble in 
water, developing great heat with the formation of caustic soda 
and the evolution of hydrogen dioxid. It is a very hygroscopic 
salt, and must be kept in tightly closed tin cans or glass bottles. 
To ascertain its efficiency, Buckley 1 has devised the following 
simple test: In a clean, dry test tube place about 15 grains 
(1 Gm.) of the powder and add to it 15 to 30 minims (1 to 2 Cc.) 



1 Buckley: Johnson's Text Book of Operative Dentistry, 1908, p. 373 



118 PHARMACO-THERAPEUTICS. 

of water. If the specimen is of a good quality, enough oxygen 
should be generated to kindle a glowing splinter held at the 
mouth of the tube. Sodium dioxid is an exceedingly active 
oxidizer. It was introduced into dentistry in 1893 by Kirk for 
the purpose of bleaching teeth (see Bleaching Agents) and for 
the treatment of putrescent root canals. (See Decomposition of 
the Tooth Pulp, etc.) For such purpose it is used as a dry 
powder or in the form of a concentrated aqueous solution. The 
latter is best prepared extemporaneously as f ollows : Place a thin 
beaker, holding a few drams of distilled water, in a basin filled 
with cold water or pounded ice, and sift slowly small quantities 
of sodium dioxid into the water until a saturated solution is ob- 
tained, which is manifested by a semi-opaque appearance of the 
latter. The dioxid solution will clear up in a few moments, 
presenting a straw-colored appearance, when it is ready for use. 
When sodium dioxid is fused, a solid mass is obtained, which is 
marketed as "oxone." (See Oxygen.) 

Sodium Diborate; Sodii Diboras; NaB0 3 -j-4H 2 ; Sodium 

Perborate. 

It furnishes from 8 to 10 percent available oxygen. It is a 
white crystalline powder, readily soluble in about 40 parts of 
water, forming a colorless alkaline solution of hydrogen dioxid. 
With a rise of temperature and the addition of small quantities 
of acids, the solubility of sodium diborate is increased and solutions 
of various strengths may be readily obtained. Extemporaneously, 
solutions of this nature may be prepared as follows: 

2-Percent (by Volume) Solution. 

Sodium diborate 30 parts. 

Boiling distilled water . . .enough to make 1,000 parts. 
Filter if necessary. 

5-Percent (by Volume) Solution. 

Sodium diborate 65 parts. 

Tartaric or citric acid, powdered 21 parts. 

Boiling distilled water. ...enough to make 1,000 parts. 
Filter if necessary. 



ANTISEPTICS. . 119 

10 to 12-Percent (by Volume) Solution. 

Sodium diborate 210 parts. 

Tartaric or citric acid, powdered 100 parts. 

Boiling distilled water enough to make 1,000 parts. 

Filter if necessary. 

On account of their mild alkalinity, these freshly made solu- 
tions of hydrogen dioxid are especially useful in those diseases 
of the mucous membrane where the acidity of the ordinary hydro- 
gen dioxid is an objection. As an addition to tooth powders, dust- 
ing powders, dry dressings, etc., sodium diborate is a valuable 
means of furnishing nascent oxygen in the presence of moisture. 

Recently some organic dioxids have been introduced. These 
substances part with their oxygen less readily than the inorganic- 
oxygen compound. Commercially, two of these compounds are 
available at present — alphozon. a sueeinyl dioxid. and acetozon. 
a benzoyl-acetyl dioxid. Both chemicals are advocated as inter- 
nal antiseptics and as bleaching agents. Their chemistry and 
physiologic action is at present not fully worked out. 

Oxygenated Talcum Powder. 

Purified talc 94 parts. 

Sodium diborate 5 parts. 

Essence of violet 1 part. 

Oxygenated Hand Cleanser (Finger Bleach). 

Castile soap, powdered 30 parts. 

Pumice stone, powdered 2 parts. 

China clay 45 parts. 

Sodium diborate 20 parts. 

Oil of sweet orange V2 part. 

Oil of bergamot Y2 part. 

Oil of bitter almonds 2 parts. 

Potassium Permanganate : Potassii Permanganas, U. S. P.. 
B. P. : KMn0 4 : Permanganate de Potasse. F. : Ueberman- 

GANSAURES KALI, G. 

Source and Character. — It appears in dark-purple or deep 
violet-red slender crystals, which have a bluish, metallic luster. 
It is odorless and has an astringent taste. It is readily soluble 



120 PHARMACO-THERAPEUTICS. 

in 15 parts of water at ordinary temperature, very soluble in boil- 
ing water, while when brought in contact with alcohol it is de- 
composed. Its aqueous solutions, which react neutral to litmus 
paper, have a deep-violet color when concentrated and a rich rose 
color when much diluted. Readily oxidizable substances — as 
glycerin, citric acid, acetic acid, tartaric acid, sugar, gum, tannin, 
etc. — are quickly oxidized when brought in contact with potassium 
permanganate solutions. When mixed with glycerin, syrup, and 
other organic liquids, or when triturated in a mortar with sul- 
phur or other inflammable bodies, the mixture readily explodes. 

Solution of Potassium Permanganate; Liquor Potassii Per- 
manganas, B. P. A 1-percent solution of the salt in water. 

A paste made of potassium permanganate, charcoal, and petro- 
latum is known as styptogan, and is used as an external styptic. 
Condy's fluid, a commercial preparation, which is much used in 
Great Britain, is a concentrated solution of potassium perman- 
ganate, and is principally employed for disinfecting purposes. 

Therapeutics. — Potassium permanganate has been much 
lauded as an oral antiseptic and deodorant. Only concentrated 
solutions are of service for such purposes, but, on account of the 
persistent discoloration of the teeth resultant from the precipita- 
tion of manganese oxid and of the deleterious action on tooth sub- 
stances, it should not be used in the mouth. In weak solutions 
(1:2,000) it is of some service in washing out abscess cavities, 
the antrum of Highmore, etc. Recently concentrated solutions 
of potassium permanganate have been recommended for the local 
treatment of snake bites. When it comes in direct contact with 
the poison it has undoubtedly some value, and it may be used 
for such purposes as a wash. 

Potassium Chlorate; Potassii Chloras, U. S. P., B. P.; 
Kalium Chloricum, P. G. ; KC10 3 . 

Synonyms. — Chlorate of potash, kali oxymuriaticum ; chlorate 
de potasse, F. ; Chlorsaures Kali, G. 

Source and Character. — It appears in colorless, shining 
plates or crystals; it is odorless, and has a soothing saline taste 
and a neutral reaction. When heated to about 634° F. (334° C.) 



ANTISEPTICS. 121 

it melts, and at a slightly higher temperature gives up free oxy- 
gen. Potassium chlorate is soluble in about 16 parts of water 
at ordinary temperature, very soluble in hot water, and soluble in 
about 130 parts of alcohol. When brought in contact with or- 
ganic matter — cork, tannic acid and its many modifications, 
sugar, etc. — or with easily oxidizable substances — sulphur, phos- 
phorus, antimony sulphid — or if the mixture is subjected to 
heat, trituration, or concussion, violent explosions are liable to 
occur. Special care should be exercised in prescribing the salt 
as a component of tooth powders. 

Therapeutics. — Potassium chlorate has a very limited range of 
usefulness. At one time it was believed that this salt possessed 
specific properties which made it invaluable for the treatment of 
infectious disturbances of the oral cavity. This belief is still en- 
tertained by many practitioners. Robert, Cushny, Heinz, and 
others have called attention to the easy manner in which this salt 
is readily absorbed by the tissues when used as a gargle. After 
it has entered the blood it produces severe changes, resulting in 
the destruction of the red blood corpuscles, with the production 
of hemoglobinuria, a condition which is known as "potassium 
chlorate poisoning." Cases are on record where the simple gar- 
gling with potassium chlorate solution has resulted in death. 
About 90 percent of the absorbed potassium chlorate is excreted 
by the urine, and the balance leaves the body through the salivary 
and other glands. Its antiseptic action is about equal to sodium 
chlorid. Recently potassium chlorate has been again introduced 
in the form of a tooth paste, containing 50 percent of the salt, 
as a panacea for the treatment of mercurial stomatitis, gingivitis, 
and other disturbances of the oral cavity. Potassium chlorate in 
the form of a paste, powder, or as a gargle in diseases of the 
mouth, or as a toilet requisite for daily use, should be emphatic- 
ally prohibited. 

Antiseptics of the Aromatic Series. 

According to the earliest historical records, the balsams, the 
spices, and wood tar and many of its derivatives have been util- 



122 PHARMACO-THERAPEUTICS. 

ized to check the effects of decay and to heal wounds. The Assy- 
rians, Persians, and especially the Egyptians employed these sub- 
stances very largely for the preservation of their dead by embalm- 
ing. Herodotus has left us a fairly good description of the meth- 
ods employed by the Egyptians. After a person had died the 
brain and abdominal viscera were removed, the body was thor- 
oughly washed and cleansed, and saturated with aromatic sub- 
stances and bitumen. It was then subjected for seventy days to a 
strong brine solution, dried, and wrapped or swathed in cloth that 
was liberally saturated with aromatics. The prepared body was 
then "laid to rest in the tomb to await the summons to the Elysian 
fields of Aahlu." With the introduction of phenol into surgery 
by Lister in 1868 the aromatics have become important factors 
in the treatment of wounds. A very largfe number of chemicals 
belonging to the aromatic series have been discovered within the 
last thirty years; some have become important constituents of 
materia medica, while others, after a very brief sojourn, have been 
discarded. 

Of the hydroxyl compounds, phenol, C 6 H 5 OH, is the most im- 
portant member; it is the oldest important representative and is 
still largely used. By substituting chlorin for hydrogen in the 
benzol ring, monochlorphenol, C 6 H 4 C10H, is formed. By oxida- 
tion three dioxybenzols are obtained, of which resorcinol, 
C 6 H 4 (OH) 2 stands out very prominently. The latter is reported 
as being an oral antiseptic of some repute. Closely related to the 
phenols are the cresols; the latter are largely used at present in 
the form of cresol, C 7 H 7 .OH — that is, a mixture of the three 
isomeric cresols, or in the form of any of the many modifications 
of which the compound solution of cresol is the best representative. 
Thymol, C 10 H 14 O, and its isomer carvacrol, are prepared from 
oil of thyme. The former is much lauded in dentistry. Of 
the naphtols the betanaphtol, C 10 H 7 OH (hydronaphtol) has 
found many admirers. Creosote, a mixture of phenol and phenol 
derivatives, prepared from beechwood tar, has been used widely 
in dentistry, even long before the inauguration of the antiseptic 
era. Its chief constituents, guaiacol, C 7 H s 2 , is much praised, 
either alone or in anv of its many modifications, as an internal 



ANTISEPTICS. 123 

antiseptic in tuberculosis. Through the introduction of the 
carboxyl group, COOH, into the aromatic series many important 
compounds are formed which are much less poisonous than the 
original phenol. Some of the important representatives of this 
group are salicylic acid and benzoic acid, and their many deriva- 
tives. A very large group of aromatic antiseptics is represented 
by the essential oils and their derivatives, and their importance 
in dentistry necessitates detailed description in a special chapter. 

The antiseptics of the aromatic series play a very important role 
in the practice of conservative dentistry and oral hygiene, and are 
principally applied locally. When the aromatic poisons are 
brought in contact with living protoplasm, they kill the cell with- 
out visible changes, and consequently they are referred to as 
protoplasm poisons. It is claimed, and clinical experience seems 
to verify this fact, that a solution of several antiseptics of this and 
other groups are more strongly antiseptic than those containing 
only an equal percentage of the individual chemical. The strong- 
est antiseptic action is obtained from those substances which are 
readily soluble in a fluid which is also soluble in the protoplasm 
of the cell. Quite a few of the antiseptics of the aromatic series 
act as caustics by precipitating albumin when applied in concen- 
trated aqueous solution. It should be borne in mind, however, 
that the newly formed precipitate is of a loose, floeculent nature, 
which does not check the further penetration of the antiseptic. 

Phenol: Phe'xol, U. S. P.; Acidtjm Carbolicum, B. P.; 
C 6 H-OH; Carbolic Acid. 

Syxoxyms. — Phenic or phenylic acid, phenyl hydroxid. hy- 
droxybenzol : acide phenique, F. ; Carbolsaure, G. 

Source axd Character.— Phenol was discovered in 1834 in 
coal tar by Runge. It is obtained from coal tar by fractional dis- 
tillation or made synthetically. It appears in colorless, needle- 
shaped crystals or white masses, having a peculiar odor and a 
sweetish, burning taste. It is deliquescent in moist air. By age 
the liquid phenol usually acquires a slightly pinkish tint ; this is 
not, however, an indication of any impurity, as it develops most 
rapidly in the pure acid and does not in any way affect its medici- 



124 



PHARMACO-THERAPEUTICS. 



nal action. Phenol is soluble in about 20 parts of pure water at 
ordinary temperature; it is very soluble in alcohol, ether, chloro- 
form, and glycerin, and in fixed and volatile oils. It reacts faintly 
acid to blue litmus paper. Phenol is frequently confounded with 
creosote, with which it is identical in many points. 

Chief Points of Difference Between Phenol and Creo- 



sote. — 

PHENOL. 

Soluble in about 20 parts of water. 
Freely soluble in glycerin. 
Crystallizable. 

Ferric chlorid test solution produces 
a permanently violet-blue color. 



CREOSOTE. 

Soluble in about 140 parts of water. 
Insoluble in glycerin. 
Not crystallizable. 

Ferric chlorid test solution produces 
a very transient violet-blue color. 



It is stated in some text books that phenol will coagulate 
albumin, while creosote will not. This certainly is a mistake, as 
both behave in exactly the same manner toward albumin. 

Average Dose. — 1 grain (0.065 Gm.). 

Medical Properties. — Antiseptic, antipyretic, caustic, anes- 
thetic. 

Preparations. — 

Phenol Liquef actum; Liquid Phenol, U. S. P.; Acidum Car- 
bolicum Liquef actum, B. P. ; Liquid Carbolic Acid. It is liquefied 
phenol, containing 10 percent of water. Average dose, 1 minim 
(0.05 Co.). 

Glyceritum Phenolis; Glycerite of Phenol, U. S. P. ; Glycerinum 
Acidi Carbolici, B. P. A mixture of 20 parts of liquid phenol and 
80 parts of glycerin. 

Unguentum Phenolis; Ointment of Phenol, U. S. P. ; Unguen- 
tum Acidi Carbolici, B. P.; Ointment of Carbolic Acid. It con- 
tains 5 percent of phenol. 

Zinci Phenolsulphonas ; Zinc Phenolsulphonate, U. S. P.; 
Zn(C 6 H 5 4 S) 2 +8H 2 0; Zinc Sulphocarbolate. It forms colorless, 
transparent crystals, odorless, and has an astringent, metallic taste. 
It is soluble in 1.7 parts of water or alcohol. 

General and Local Action. — Phenol, when administered 
internally in very diluted form, is promptly absorbed and exercises 
a definite influence on the central nervous system. It acts as a 
depressing and stupefying agent, but rarely produces convulsions 



ANTISEPTICS. 125 

in man. The respiration and the heart's action are accelerated 
and the temperature is slightly decreased, while the secretions are 
increased. The urine becomes brownish-black ; it should be under- 
stood that this discoloration is not due to the presence of blood, 
but is due to the phenol administration. Locally applied, phenol 
acts as a general protoplasm poison. Phenol solutions are only 
weakly ionized; their action does not depend so much on the ion, 
GgHgO, as on the whole molecule, C 6 H g OH, and this is partially 
the reason why the phenol salts, which are much more readily dis- 
sociated in solution, are much less active antiseptically. Phenol 
precipitates albumins and proteins, but the resultant precipitate 
is quite different from that formed by tannic acid or the metallic 
salts. The phenol precipitate of albumin is of a loose, flocculent 
nature ; it does not prevent the further penetration of the phenol, 
and the latter may be readily washed out from the precipitate. 
The question of phenol coagulation at one time gave rise to heated 
discussions in dental circles until York, in 1899, proved the sound- 
ness of the above mentioned facts. On bacteria the action of 
phenol varies greatly with the species of the micro-organisms. The 
ordinary pyogenic bacteria are usually readily destroyed by a 3 
to 5-percent solution, Avhile spores are very resistant even to con- 
centrated solutions. "When applied to the skin in concentrated 
solution, phenol produces a white opaque scar, which falls off in 
a few days, leaving a light, reddish-brown stain, which may 
remain for several days, or even weeks. Even in weak solution 
(5-percent), when applied for some time and prevented from 
evaporation, it may produce necrosis of the parts. Numbness of 
the covered area, or even almost complete anesthesia, may accom- 
pany the phenol application. If phenol is applied to mucous 
membranes in concentrated solution, it produces sloughing, and 
acute inflammation may follow. Sometimes general effects are 
observed from the absorption of large quantities of the solution 
when applied locally. Phenol is rather a poor deodorant as 
compared with cresol and similar bodies. It should be remem- 
bered, however, that deodorization does not mean antiseptic action. 
Therapeutics. — The antiseptic value of phenol in solution 
depends largely on the solvents used. If a chemical is to penetrate 



126 PHARMACO-THERAPEUTICS. 

into the structure of an organism (bacterium), it must be as solu- 
ble in the cell fluids as in the fluids in which it is applied. Koch 
pointed out long ago that phenol and other antiseptics dissolved 
in alcohol or in oil are practically valueless when applied as anti- 
septics. It is interesting to observe that, on the other hand, the 
addition of small quantities of sodium chlorid to an aqueous phe- 
nol solution increases its antiseptic action very markedly. No 
plausible explanation of this phenomenon is offered at present. 
Temperature also has a decided influence on the antiseptic action 
of phenol solution. Raising the temperature to 120 to 140° F. 
(50 to 60° C.) increases its disinfecting action very materially. 
Phenol solutions are rarely used at present for surgical purposes; 
its irritating action and the possibility of producing necrosis are 
probably the chief factors of its elimination from wound surfaces. 
As a gargle from 1 to 2-percent solutions are employed. Carbo- 
lated oil or vaselin (5 to 10 percent) are recommended as lubri- 
cants for surgical instruments. Liquid phenol is quite freely used 
as a caustic for small tumors, gum tissue, fistulous tracts, abscess 
cavities, etc. Its application should be always immediately fol- 
lowed by alcohol to limit its action. 

Toxicology. — Phenol is frequently taken with suicidal intent. 
It is a most deadly poison, and usually produces its effects very 
quickly. The odor of phenol and the caustic action on the mucous 
membranes of the mouth and the lips are in most cases readily 
recognizable symptoms of phenol poisoning. The treatment con- 
sists of the removal of the poison with the stomach tube and the 
administration of demulcent drinks, as white of egg, or lime sus- 
pended in sugared water. Lavage of the stomach with 10-percent 
alcohol, followed with plain water, is indicated. Sodium or mag- 
nesium sulphate in large quantities, well diluted, have been recom- 
mended in the hope of forming insoluble sulpho-carbolates, but 
they are apparently of little value. Heat applied to the body sur- 
faces and general stimulants are useful adjuncts. The internal 
administration of alcohol in the belief of forming definite chemic 
inert compounds with phenol is a mistaken idea, as there is no 
evidence of chemic antagonism between the two substances. Vine- 
gar given in large quantities has also proved to be effective. Re- 



ANTISEPTICS. 127 

certly tincture of iodin administered in very diluted form, one 
dram (4 Cc.) in a tumblerful of water, has been found to be ser- 
viceable. The local caustic effects of phenol may be quickly miti- 
gated by washing the parts with alcohol, which quickly dissolves 
the phenol, and then covering the cauterized surfaces with a 
bland ointment. 

Quite a large number of phenol compounds have been favorites 
with dental practitioners. Some of the better known compounds, 
including their approximate composition, are the following: 

Solution of Sodium Phenate (Phenol Sodique). 

Phenol crystals 30 parts. 

Sodium hydrate 2 parts. 

Water 28 parts. 

Dissolve the sodium hydrate in the water, add the phenol, 
and warm gently. 

Camphorated Phenol; Carbolated Camphor; Campho- 

Ppienique. 

A solution of camphor in phenol and alcohol. It is a simple 
solution of the three components, and not a new chemic compound 
which, as is claimed, results from the reaction of the above solu- 
tion. It is much less caustic than phenol, the camphor and the 
alcohol solvents, as stated above, preventing its ready action on 
the tissues. 

Phenol crystals 30 parts. 

Camphor 60 parts. 

Alcohol 10 parts. 

Place the three components in a dry bottle, and within a few 
hours they will form a homogeneous liquid. 

Phenolated Thymol; Thymol-Camphene. 

A solution of phenol, thymol, and camphor. It is much lauded 
in the treatment of putrescent root canals. 

Phenol crystals 2 parts. 

Thymol 2 parts. 

Camphor 1 part. 

Place the three components in a dry bottle, and within a few 
hours they will form a hcmcgeneous liquid. 



128 PHARMACO-THERAPEUTICS. 

Phenosalyl. 

Phenol crystals 9 parts. 

Salicylic acid 1 part. 

Lactic acid 2 parts. 

Menthol Vio part. 

Black's 1-2-3. 

Oil of cassia 1 part. 

Phenol crystals 2 parts. 

Oil of wintergreen 3 parts. 

Arkovy's Mixture. 

Phenol crystals 2 parts. 

Camphor 1 part. 

Oil of eucalyptus 1 part. 

MoNOCHLOROPHENOL J PARA-MONO-CHLORO-PHENOL ) 
C 6 H 4 Cl(OH). 

A product of chlorin substitution, replacing one or more hydro- 
gen atoms of phenol. It appears in colorless crystals, very soluble 
in ether and alkalies, less soluble in water. In many respects it 
acts like phenol, but it is much more poisonous to micro-organ- 
isms. It possesses very strong disinfecting properties, and has 
a great power of penetration. It acts as a valuable obtundent. 
AValkhoff, Homer, Dorn, Michel, and others have lauded its 
value in the treatment of pyorrhea alveolaris. 

Creosote; Creosotum, U. S. P., B. P.; Beechwood Creosote; 

Oil of Smoke. 

Source and Character. — Creosote is a mixture of phenols 
and phenol derivatives, chiefly guaiacol and cresol, obtained from 
wood tar, preferably from beech tar. It is an almost colorless, 
yellowish oily liquid, with a smoky odor and a burning, acrid 
taste. It is soluble in about 140 parts of water at ordinary tem- 
perature, readily soluble in alcohol, ether, chloroform, and fixed 
or essential oils. 

Average Dose. — 3 minims (0.2 Cc). 

Therapeutics. — Creosote was introduced into dentistry soon 
after its discovery by Reichenbach (1830), and it at one time 



ANTISEPTICS. 129 

occupied a very prominent place in dentistry, being the most im- 
portant antiseptic used for the treatment of diseases of the pulp. 
At present it is obsolete, and phenol, cresol, and the many modern 
antiseptics have taken its place. Creosote — that is, beech wood 
creosote — should not be confounded with coal tar creosote, a sub- 
stance prepared from coal tar. The latter is of a different compo- 
sition and poisonous, and should not be substituted for beech- 
wood creosote. 

Guaiacol ; Guaiacol, U. S. P. ; C 7 H 8 2 . 

It is one of the principal products of beechwood creosote, or 
prepared synthetically. It is a colorless crystalline solid, melting 
at about 85° F. (30° C), or a colorless refractive liquid, having 
an agreeable aromatic odor. It is soluble in about 55 parts of 
water, in alcohol, ether, and glycerin. 

Guaiacol Carbonate, U. S. P., also known as duotal, is a deriva- 
tive of the above compound. Average dose, 8 minims (0.5 Gm.). 

Cresol; Cresol, U. S. P.; C 7 H 7 .OH; Tricresol. 

Source and Character. — Cresol presents a mixture of three 
isomeric cresols obtained from coal tar, freed from phenol, hydro- 
carbons, and water. Commercially the mixture is known as 
tricresol. It is a straw-colored reactive liquid, having a phenol- 
like odor and turning brown on prolonged exposure to light. 
Cresol is soluble in 60 parts of water at ordinary temperature, and 
it is miscible with alcohol, ether, glycerin, and alkali hydroxid 
solution. By fractional distillation the following constituents are 
obtained : 

Orthocresol, at about 371° F. (188° C), colorless crystals. 

Paracresol, at about 389° F. (198° C), crystalline masses. 

Metacresol, at about 394° F. (201° C), light-yellowish liquid. 

Average Dose. — 1 minim (0.05 Cc). 

Therapeutics. — Cresol is a strong antiseptic, resembling 
closely phenol in its general action. It is said to be about three 
to four times as strong as phenol, but less poisonous. Meta- 
cresol is by far the most active of the cresols. The cresols are 
principally used as external antiseptics and as germicides. Like 



130 PHARMACO-THERAPEUTICS. 

all phenols, they act as local obtundents. The cresols are soluble 
in solutions of certain organic substances- — in soap solution and 
other alkaline solutions. The most important representative of 
this group is: 

Compound Solution of Cresol; Liquor Cresolis Compositus, 
U. S. P. ; Lysol. It is a 50-percent solution of cresol in a linseed 
oil soap; it mixes freely with water, forming a clear solution, 
which is very soapy in its nature. Solveol and solutol are sim- 
ilar compounds, while creolin is an emulsion of cresols with resin 
soap. 

Benzoic Acid; Acidum Benzoicum, U. S. P., B. P.; HC 7 H 5 2 . 

Synonyms. — Flowers of benzoin ; acide benzoique, B. ; Benzoe- 
saure, G. 

Source and Character. — An organic acid obtained from 
benzoin by sublimation, or prepared artificially, usually from 
toluol. It may be prepared also from hippuric acid and other 
organic compounds. It appears in light, feathery needles, having 
a slightly aromatic odor and a warm, acid taste. It is soluble in 
about 281 parts of water and 15 parts of boiling water, readily 
soluble in alcohol, ether, and in fixed or volatile oils. Its solu- 
bility in water is much increased by the addition of borax or other 
alkalies. It is incompatible with mercuric chlorid and many of 
the other metallic salts. Benzoic acid should be preserved in 
amber-colored bottles. 

Average Dose. — 7 1 / 2 grains (0.5 Gm.). 

Medical Properties. — Antiseptic, disinfectant, and anti- 
pyretic. 

Therapeutics. — A 1-percent solution of benzoic acid will 
sterilize the oral cavity in about half a minute. (Miller.) It is 
preferable in many respects over thymol, phenol, and similar 
preparations as an effective constituent of mouth washes. It is 
almost nonpoisonous, and has no irritating effect on the mucous 
membrane. Tooth structure is apparently not affected by benzoic 
acid. Internally, benzoic acid and its salts are administered to 
increase the amount of expectoration by stimulating the secre- 
tions and the respiratory organs. 



ANTISEPTICS. 131 

Salicylic Acid; Acidum Salicylicum, U. S. P., B. P.; 

HC 7 H 5 3 . 

Synonyms. — Ortho-oxybenzoic acid ; acide salicylique, F. ; 
Salicylsaure, G. 

Source and Character. — Salicylic acid is known since 1834 
to exist in the form of an aldehyd (salicin) in many plants, espe- 
cialty in the oils of wintergreen, sweet birch, willow bark, etc. 
At present it is usually prepared synthetically. Salicylic acid 
appears in light, fine white needles; it is odorless, having a sweet- 
ish, afterward acrid, taste. It is soluble in about 310 parts of 
cold and in 14 parts of boiling water, in 2 parts of alcohol, in 80 
parts of glycerin, and in ether and chloroform. It is incompati- 
ble with ferric salts, quinin, and spirits of nitrous ether. 

Average Dose. — 7 1 / 2 grains (0.5 Gm.). 

Medical Properties. — Antipyretic, antiseptic, antirheumatic, 
and anhidrotic. 

Preparations. — 

Phenyl Salicylate; Phenylis Salicylas, U. S. P. ; Salol, B. P. ; 
C 13 H 10 Oo. Salol is prepared by the interaction of a sodium 
salt of salicylic acid and phenol with phosphoryl chlorid. It 
appears as a white crystalline powder, with a faintly aromatic 
odor and little taste. It is freely soluble in ether and alcohol, 
almost insoluble in water. Average dose, 7 1 / 2 grains (0.5 Gm.). 

Sodium Salicylate; Sodii Salicylas, U. S. P., B. P. ; NaC 7 H-0 3 . 
Sodium salicylate is a white odorless powder, with a sweetish, 
saline taste; it is very soluble in water. Average dose, 15 grains 
(1 Gm.). 

Aspirin; Acetylsalicylic Acid. It is a white powder, slightly 
soluble in water, but readily soluble in alcohol. It has a very 
slightly acid taste. It has a well-earned reputation as an anal- 
gesic. Average dose, 7 1 / 2 grains (0.5 Gm.). 

Tpierapeutics. — As salicylic acid is only sparingly soluble in 
water, it is seldom employed as an antiseptic, although it is almost 
equal in strength to phenol. It is extensively used as a surgical 
dressing in the form of cotton wool impregnated with the acid. 
Formerly it was highly praised as a mouth wash in alcoholic 
solution. Salicylic acid acts very deleteriously on tooth structure, 



132 PHARMACO-THERAPEUTICS. 

and even in y i0 -percent solution it will affect the enamel. Its 
sodium salt is used as a specific for acute rheumatism; it reduces 
the temperature and the pain, and removes the local symptoms 
of this disease. Asperin and similar preparations have largely 
supplanted the use of salicylic acid and sodium salicylate. 

Salol is the principal constituent of a much advertised proprie- 
tary mouth wash; it is broken up by the saliva into its compo- 
nents — salicylic acid and phenol — and is as detrimental to the 
enamel of the teeth as salicylic acid alone. The prolonged use 
of a salol solution as a mouth wash is very apt to produce morbil- 
liform eruptions about the lips, especially about the corners of the 
mouth, which are known as "mouthwash eczema." 

Chinosol ; Chinosol ; C 9 H 6 .N.KS0 4 . 

Synonyms. — Potassium oxychino-sulphate ; oxychinolin alum. 

Source and Character. — Chinosol is obtained from the inter- 
action of oxychinolin (chinophenol) and potassium pyro-sulphate 
in alcoholic solutions. It occurs in the form of a crystalline* 
lemon-yellow powder, having a pleasant aromatic odor and an 
astringent taste. It is very freely soluble in water; insoluble in 
alcohol and ether. It is incompatible with the alkaline salts and 
the salts of iron. Steel instruments will be blackened, but not 
corroded, when brought in contact with it; the stain is easily 
removed by polishing with an abrasive. 

Medical Properties. — Antiseptic, styptic, and antipyretic. 

Therapeutics. — Administered internally, chinosol acts as a 
prompt antipyretic and intestinal antiseptic. It is lauded as a 
specific in influenza and general "colds." Externally applied, it- 
is a very efficient nontoxic antiseptic. It is claimed that its germi- 
cidal power is in many respects equal to that of mercuric chlorid. 
It does not coagulate albumin, is very diffusible, and has no 
caustic effect on tissues. Grunert, in 1895, introduced it into den- 
tistry, and called special attention to its great deodorizing power 
and its destructive effects on pus micro-organisms. Bohm, Cook, 
MaWhinney, and others have lauded it very highly as an oral 
antiseptic. As a general antiseptic, aqueous y i0 -percent solu- 
tions are usually employed. For injection into pus cavities. 1 or 



ANTISEPTICS. 133 

2-percent solutions are recommended. Good results are obtained 
with it in the form of weak solutions and as gauze packings in 
the treatment of empyema of the antrum. Prolonged use in the 
mouth slightly darkens the teeth. 

Chinosol has been recently reintroduced into dentistry in tablet 
form under the name of Keys-All; each tablet contains 1 grain 
(0.06 Gm.). 

Resorcinol; Resorcinol, U. S. P.; C 6 H 6 2 . 

Synonyms. — Resorcin, metadioxybenzol. 

Source and Character. — A neutral or slightly acid diatomic 
phenol obtained from benzol by various processes. It is found 
in galbanum, asafetida, ammoniac, and other gum resins. It 
appears in colorless or slightly pinkish crystals, having a faint 
odor and a sweetish, disagreeable taste. It is soluble in 0.5 parts 
of water or alcohol, readily soluble in ether and glycerin. It is 
incompatible with ferric salts and bromin water. 

Average Dose. — 2 grains (0.125 Gm.). 

Medical Properties. — Antiseptic and disinfectant; internally, 
antipyretic. 

Therapeutics.— Resorcinol is much lauded as an antiseptic 
for the oral cavity. A 2-percent aqueous solution, flavored with 
an essential oil, may be used with impunity as a mouth wash. 
While resorcinol seems to be as antiseptic as, or even more strongly 
antiseptic than, phenol, it is at present seldom employed as a 
substitute for the latter. In the form of an ointment (5 to 10 
percent) it is much used in skin diseases. 

Betanaphtol ; Betanaphtol, U. S. P. ; C 10 H 7 OH'; Naphtol. 

Source and Character. — A monatomic phenol occurring in 
coal tar, but usually prepared from naphthalene. It appears as a 
pale buff colored, shiny crystalline powder, having a faint phenol- 
like odor and a sharp, pungent taste. It is soluble in about 950 
parts of water, very soluble in alcohol and ether. Hydronaphtol, 
a proprietary preparation, is claimed to be an impure beta- 
naphtol. 

Average Dose. — 4 grains (0.25 Gm.). 



134 PHARMACO-THERAPEUTICS. 

Medical Properties. — Antisepctic and disinfectant. 

Therapeutics. — Alcoholic solutions of betanaphtol in various 
concentrations are recommended as mouth washes, especially in 
pyorrhea alveolaris. 

Betanaphtol Mouth Wash. 

I£ Betanaphtol gr. xx (1.3 Gm.) 

Alcohol. 
Glycerin. 

Aquae aa flg j (30 Cc.) 

M. 

Sig. : Half teaspoonful in a small glass of warm water, to 
be used twice a day. (James Truman.) 

Antiseptic Cavity Varnish. 

Select gum copal 10 parts. 

Ether 12 parts. 

Betanaphtol 1 part. 

Sig. : Dissolve the copal and the betanaphtol in the ether, 
filter through a well-covered filter, and add enough ether to 
make the whole measure 18 parts. Keep in well-stoppered 
bottles. 

Balsam of Peru; Balsamum Peruvianum, U. S. P., B. P.; 
Baume des Indes, F. ; Peruvianischer Balsam, G. 

Source and Character. — Balsam of Peru is obtained from 
Toluifera Pereirse, Bailton, family Leguminosds, a tree growing in 
San Salvador. It is a thick, viscid liquid, having a brown color 
and an agreeable vanilla-like odor. Its taste is of a bitter, acrid 
nature and -very persistent. It is completely soluble in absolute 
alcohol, chloroform, and glacial acetic acid, partially soluble in 
ether, and soluble in 5 parts of alcohol. Water, when agitated 
with the balsam, shows an acid reaction to blue litmus paper. 
Balsam of Peru consists of 65 percent of perubalsam oil, known 
as cinnamen, of vanillin, cinnamic acid, and about 35 percent 
of resinous substances. The balsam is quite frequently sophisti- 
cated with cheaper balsams and essential oils. 

Average Dose. — 5 to 30 minims (0.3 to 2 Cc). 

Therapeutics. — Balsam of Peru enjoys quite a reputation in 



ANTISEPTICS. 135 

the treatment of skin diseases. Recently Suter 1 tested its anti- 
septic qualities, and found that the viscid balsam is, in a certain 
sense, a reservoir of bactericidal substances, which gradually 
diffuse to the surrounding medium and which mechanically and 
chemically interfere with the growth of bacteria. It also pos- 
sesses chematactic properties. Mayrhofer 2 recommends the bal- 
sam very highly as the ideal root filling material in asepticized 
canals. He injects the balsam with a small syringe and covers it 
with cement or amalgam. He claims that balsam of Peru is a 
very persistent antiseptic, which fills every nook of the root canal 
and does not change its volume, nor does it discolor the tooth. 
Some years ago a preparation known as "balsamo del deserto," 
which resembled balsam of Peru to some extent, was much lauded 
as a root filling material. At present it is apparently little used. 
Other balsams and balsamic resins — as balsam of Tolu, styrax, 
benzoin, etc. — are seldom employed in their pure state as anti- 
septics. 

Picric Acid ; Acidum Picricum ; C 6 H 3 N 3 7 ; Picronitric Acid ; 

Trinitrophenol. 

It occurs in yellow, lustrous crystals, odorless, and having an 
intense bitter taste. It is soluble in 10 parts of alcohol, 6.0 
parts of ether, and 170 parts of water. It is readily oxidized, and 
forms dangerous compounds when mixed with sulphur, phos- 
phorus, etc. It should never be applied in substance. It is 
claimed that a hydro-alcoholic solution of picric acid is extremely 
useful in all forms of burns. 

Solution for Burns. 

ty. Acid, picric. 5 i ss (6-0 Gm.) 

Alcohol. AS ij (60 Cc.) 

Aq. destillat. ad flg xxxij (1,000 Cc.) 

M. 

Sig. : Strips of lint are soaked in this solution, placed 
over the burned surface and kept moist with it. 



1 Suter: In Prinzipien der Pulpagangran, by Mayrhofer, 1909. 

2 Mayrhofer: See Suter. 



136 PHARMACO-THERAPEUTICS. 

Antiseptics of the Marsh Gas Series. 

Marsh gas (methan, CHJ furnishes the basic formula of a 
very large group of organic compounds that have been used with 
remarkable success in therapeutics. The vast majority of these 
compounds are characterized by a depressing action on the nerv- 
ous system. The hydroxyl compounds of certain derivatives of 
methan are known as alcohols. The simplest form rs methyl 
alcohol, CH 3 OH, a product of oxidation of methan. Methyl 
alcohol is rarely used as an antiseptic, and when further oxidized 
it produces a gaseous aldehyd, 1 CH 2 0-j-H 2 0, known as formal- 
dehyd, according to the following equation : 

CH 3 OH+0=CH 2 0+H 2 0. 

This latter compound is one of the most powerful disinfectants 
at our command. By substituting one H-atom of methan by the 
molecule CH 3 , a second radical of marsh gas is produced known 
as ethan, C 2 H 6 . If one H-atom of ethan is replaced by the 
hydroxyl group, OH, ethyl alcohol, C 2 H 5 OH, is obtained. By 
further increased substitutions of the H-atom of methan, a num- 
ber of higher alcohols — such as the propyl, butyl, and amyl alco- 
hols — are obtained. Their therapeutic application is very 
limited. 

Solution of Formaldehyd ; Liquor Formaldehydi, U. S. P. ; 
Formalin; Formol; Formicaldehyd ; Oxymethylen. 

Source and Character. — An aqueous solution of not less than 
37 percent of absolute formaldehyd (H.CO.H.). It is an oxida- 
tion product of methyl alcohol. Water will take up about 52 
percent of formaldehyd gas, but it will not retain more than 35 
to 40 percent at ordinary temperature. On standing, slight sepa- 
ration of paraformaldehyd takes place. It is a clear, colorless 
liquid, having a pungent odor and a caustic taste. Its vapors are 
very irritating to the mucous membrane. It is readily miscible 
with water and alcohol, and its solutions react neutral or faintly 
acid to litmus paper. It is incompatible with ammonia, alkalies, 



1 An aldehyd is a dehydrogenated alcohol. 



ANTISEPTICS. 137 

tannic acid, gelatin, iron preparations, and the salts of copper, 
iron, or silver. 

Preparations. — 

Paraform; Trioximethylen; Paraformaldehyde It is prepared 
by polymerizing formic aldehyd by heat. It is a white crystalline 
powder, very slowly soluble in water, alcohol, or ether, and melt- 
ing at 340° F. (171° C). At ordinary temperature it gives up 
formaldehyd vapors, which are readily increased by heat. Para- 
form is largely used for disinfecting purposes, and forms an im- 
portant component of the many mummifying pastes that are em- 
ployed for the preservation of pulp stumps left in root canals. 

Phenyform. Is a condensation product of phenol and formal- 
dehyd. It is a grayish-white powder, devoid of odor, soluble in 
alkalies and alcohol, but insoluble in water or ether. In the 
presence of animal secretions and tissue fluids it splits up into its 
components. It has been used to some extent as a wound anti- 
septic. 

Hexamethylenamin ; Hexamethylenamina, IT. S. P.; Urotropin; 
Amino form; Formin; Cystogen. A condensation product ob- 
tained by the action of ammonia on formaldehyd. It is soluble 
in 1.5 parts water and in 10 parts alcohol. Average dose, 4 grains 
(0.25 Gm.). 

Formamint. A compound of formaldehyd and sugar of milk 
is compressed into small tablets containing iy 2 grains (0.01 
Gm.) of active formaldehyd, flavored with menthol, citric acid. 
etc. The tablets are dissolved in the mouth, and thus a slow, 
continuous action of formalin is obtained. 

Lysoform; Yeroform. It is a solution of an alkaline potassium 
soap containing formaldehyd. The liquid has comparatively little 
of the formaldehyd odor, and is much less irritating. It is a 
useful agent for the disinfection of hands, instruments, etc. 

Formagen. A dental cement, containing formalin. It is used 
for the purpose of filling root canals, etc. 

Cresol-Formothymol. A liquid compound prepared by dis- 
solving thymol in an alcohol solution of formaldehyd gas, to 
which 20 percent of cresol is added. It is used as a substitute for 
the cresol formalin mixture. 



138 PHARMACO-THERAPEUTICS. 

General and Local Action. — The vapors of formaldehyd 
are intensely irritating to the mucous membrane, the eyes, etc. 
Taken internally, it produces severe gastro-enteritis, followed 
by collapse and death in a very short time. Two ounces of com- 
mercial formaldehyd solution are known to have killed a man. 

Locally applied in diluted solutions, it roughens the skin, and 
concentrated solutions tan the skin to such an extent that the 
superficial layers, which have changed to a horny material, may 
be removed in shreds. If the ear of a living rabbit is thoroughly 
painted with a formaldehyd solution for some time, it becomes 
mummified and may be readily broken off. Meats (hams, sau- 
sage, etc.) treated with formaldehyd become hard as rock, and 
consequently this compound can not be used as a preservative of 
food stuffs. Its use as a preservative of milk is prohibited in 
many cities and states. For the preservation of physiologic and 
pathologic specimens it is very serviceable, as it does not change 
the normal color of the tissues. On the mucous membrane for- 
maldehyd, even when applied in very diluted solutions, acts as 
an irritant, and in concentrated solution it acts as a powerful 
caustic. Consequently formaldehyd should not be used as a com- 
ponent of mouth washes, and the many proprietary preparations 
that contain it should not be continuously employed, as they tan 
the oral linings and thus lessen their resistance. 

Formaldehyd is a very powerful germicide. According to 
Loew Its bactericidal action on micro-organisms and their prod- 
ucts is believed to be due to its affinity for certain amino groups 
in the proteins. When formaldehyd is added to a solution of 
albumin or serum, a peculiar chemic compound results that is 
not precipitated, nor are the albumins so treated precipitated by 
heat. Applied in vapor form, it is one of the most certain means 
of disinfecting rooms and their contents. 

Disinfection of Rooms. The room to be disinfected should 
have a temperature of 65° F. (18° C.) or more, and the air 
present must contain at least 75 per cent of moisture. This 
humidity can be produced by placing pans of steaming hot water 
about the room. Drawers, closet doors, etc., should be opened, 
and the furniture moved from the walls. Set on the floor in the 



ANTISEPTICS. 139 

middle of the room a large tin bucket, in which place a tin can 
of suitable capacity. Put into the can six ounces of potassium 
permanganate crystals, and pour over them one pint of commer- 
cial formaldehyd solution. This quantity is sufficient for every 
thousand cubic feet of air space. The operator should leave the 
room at once, as large quantities of formaldehyd gas are imme- 
diately evolved. The room must be closed air tight, and not 
opened for at least six hours. Furniture, draperies, carpets, pic- 
tures, etc., are not damaged by this method of disinfection. After 
the disinfection is completed, the formaldehyd gas can be neutral- 
ized by ammonia, so as to render the room fit for occupation. 
This may be readily accomplished by placing in a suitable vessel 
two pounds of freshly burnt lime, seven pints of boiling water, 
and three pints of strong ammonia water. After one hour's 
exposure to the ammonia vapors the room should be well aired. 

Therapeutics. — Formaldehyd is much restricted in its thera- 
peutic application by its^powerful irritating property, its pungent 
odor, and by the rapid volatilization of the gas. To remove or 
neutralize these properties, a number of compounds have been 
produced by utilizing the peculiar affinity which formaldehyd has 
on starch, gelatin, and albumin solutions. The resulting products 
are respectively known as amyloform, glutol, and formalbacid. 
These compounds have been used to some extent in minor surgery 
and dermatology, but are largely abandoned at present. Tt is 
also known that formaldehyd is readily liberated from certain 
organic compounds in the genito-urinary tract when taken inter- 
nally. Nascent formaldehyd readily forms soluble compounds 
with uric acid. Since this fact became known innumerable com- 
pounds have been forced on the market, among which hexame- 
thylenamin (also known as urotropin, formin, saliformin, and 
cystogen), tannopin, tannoform, urasol, formidin. etc., are the 
most prominent members. Thorald Sollman has recently shown 
that "of all the products examined for antiseptic value, hexa- 
methylenamin is the only one which offers undoubted advantages 
over the other antiseptics." 

As an antiseptic, formaldehyd has gained an enviable reputa- 
tion in conservative dentistry. It is somewhat difficult to state 



140 PHARMACO-THERAPEUTICS. 

at present who introduced this chemical into our profession. 
While we find some references relative to its dental use as early 
as 1894/ the earliest important communications are those made 
by Marion 2 (1895), Lepkowski 3 (1895), Schroder 4 (1896), Wit- 
zel 5 (1908), Bonnecken 6 (1898), Prinz 7 (1898), etc. They are 
now followed in rapid succession by many writers here and 
abroad. On account of its strong irritating action, formaldehyd 
is diluted or combined with many other agents — alcohol, oil of 
geranium, cresol, phenol, etc. — and has been principally em- 
ployed ever since in mixtures of this nature. In 1899 Gysi 8 intro- 
duced a mixture of cresol and formalin for the treatment of pulp 
gangrene and for the mummification of pulp stumps left in the 
root canals, but it remained for Buckley 9 to bring this combina- 
tion prominently before the Fourth International Dental Congress 
in 1904. Buckley is entitled to the credit of having completely 
changed and simplified the routine treatment of pulp gangrene. 
Since the original publication of Buckley appeared, the literature 
on this interesting subject has grown enormously, and quite a 
number of pages could be filled by merely mentioning the titles 
of the many literary efforts advocating cresol-formalin, but a 
few lines will suffice to record the names of those who have con- 
tributed really meritorious communications. 

In the current literature on the treatment of putrescent pulps 
the term asepsis, antisepsis, and sterility are frequently employed 
in a rather loose manner, which may lead to serious misinterpre- 
tations. Asepsis indicates an absence of pathogenic bacteria ; anti- 
sepsis means inhibition of the pathogenic bacteria, but with no 
interference with their spores; and sterilization implies the de- 
struction of all vegetative organisms, their spores, and their prod- 
ucts. An incipiently infected root canal of a pulpless tooth in 
situ may be rendered aseptic by the free use of antiseptics, but 



1 British Dental Journal, April, 1894; Cassidy: Transact. Am. Dental Ass. 1894. 

2 Marion: L'Odontologie, January, 1895. 

3 Lepkowski: Verhandlungen der Deutschen Odontologischen Gesellschaf t, Vol. VII, 1896. 

4 Schroder: Deutsche Monatsschrif t fur Zahnheilkunde, June, 1896. 

5 Witzel: Deutsche Monatsschrif t fur Zahnheilkunde, December, 1898. 

6 Bonnecken: Osterreich-Ungarische Vierteljahrsschrift fur Zahnheilkunde, January, 1898. 

7 Prinz: Dental Review, October, 1898. 

8 Gysi: Schweizer Vierteljahrsschrift fur Zahnheilkunde, No. 1, 1899. 

9 Buckley j Transactions of the Fourteenth International Dental Congress, Vol. II, 1905. 



ANTISEPTICS. 141 

it is impossible to sterilize the tooth structure. To sterilize a tooth 
means to remove it bodily and thoroughly boil it. 

The treatment of a putrescent pulp depends, like any other 
surgical procedure which deals with severe infection, on chemic 
and mechanical measures. The mechanical removal of the 
putrescent pulp is the foundation of the successful conservative 
treatment of the tooth. The introduction of the cresol-formalin 
mixture by Buckley for the purpose of therapeutically treating 
pulp infections places this procedure on a rational basis, which, 
on account of its importance to the practice of operative dentistry, 
deserves to be discussed in detail. 

Decomposition of the Tooth Pulp and Its Treatment with 
Formaldehyd-Cresol. The human tooth pulp — that is, the sound, 
healthy pulp — consists of connective tissue, nerves, and blood 
vessels, and so far no lymphatics have been traced in the pulp 
mass. The animal tissues are essentially composed of cells, and 
the constituents of the cells consist of protein, lipoids, salts, and 
water. Only a very few elements enter into their make-up — 
nitrogen, oxygen, carbon, hydrogen, sulphur, and very little phos- 
phorus and iron. The tissues containing nitrogen are referred 
to as nitrogenous substances, or proteins, while nonnitrogenous 
substances are spoken of as carbohydrates and fats. The normal 
pulp tissue is composed principally of protein material, and so 
far no carbohydrates or free fats have been isolated from it. The 
proteins are the most complex bodies known to chemistry; they 
are usually colloidal in their nature, and are composed of mole- 
cules that differ widely in their weight and size. The average 
protein molecule approximately furnishes the following constitu- 
ents: Carbon, 51 to 55 percent; oxygen, 20 to 24 percent; nitro- 
gen, 15 to 17 percent; hydrogen, 6.8 to 7.3 percent; sulphur, 0.3 
to 0.5 percent, and very small quantities of phosphorus and iron. 
The proteins may be decomposed by acids, alkalies, superheated 
steam, digestive ferments, and bacteria. In the decomposition of 
the pulp we are principally concerned with the last two processes. 
Death of the pulp — necrosis — is the progenitor of pulp decompo- 
sition — gangrene. 

Whenever healthy tissue becomes irritated by mechanical, 



142 PHARMACO-THERAPEUTICS. 

physical, or chemic (including bacteria) means to such an extent 
as to cause intense disordered cell nutrition, death of the cells 
results. This process is known as necrosis. A pulp may acci- 
dentally die of its own accord through any of the above causes, 
or it is artificially killed by a caustic, usually arsenic trioxid. Tn 
general pathology we recognize four distinct forms of necrosis: 

1. Coagulation Necrosis. This form of necrosis results from 
the coagulation of fluids that have entered into or are present in 
the pulp, and that contain coagulable substances — that is, the 
soluble colloidal material is transformed into insoluble modifica- 
tions. The change of fibrinogen into fibrin is an important factor 
in this procedure. The pulp assumes a dry, firm appearance, and 
is usually of a yellowish color. When blood enters into the root 
canal after the removal of a coagulated pulp, it usually becomes 
quickly clotted. Coagulation necrosis may be caused by heat, 
phenol, corrosive sublimate, and other chemicals, and it is rather 
seldom met in the dead dental pulp. 

2. Liquefaction or Colliquation Necrosis. This occurs princi- 
pally in the central nervous system. The nature of this form of 
necrosis is not quite clear, and probably edematous infiltration 
and enzyme action have much to do with it. Tt is very rarely 
found in the dead pulp. Suppuration, which in reality is a form 
of liquefaction necrosis, should not be confounded with it. It is 
principally due to bacteria, or to the action of chemic substances 
(aseptic suppuration). 

3. Caseation Necrosis. This is a coagulation necrosis, which 
resembles an emulsion of fat and water, and has the appearance 
of cheese. The coagulum is made up of protein derivatives, con- 
siderable quantities of fat and water, etc. Fatty degeneration of 
the pulp as a whole is rarely met. The fat globules are derived 
from the disintegration of cejl protoplasm, which contains fat 
as a metabolic constituent, The action of proteolytic enzymes 
(trypsin) is probably largely responsible for these changes. 
Caseation is frequently found in pulp decomposition. 

4. Gangrene. Gangrene is the result of putrefactive changes 
or desiccation occurring in necrotic tissues. Two forms of gan- 
grene are usually recognized in general pathology — moist and 



ANTISEPTICS. 143 

dry gangrene. Moist gangrene depends on the presence of water, 
while the absence of water denotes dry gangrene or mummifica- 
tion. In dry gangrene nearly all further changes cease, while 
in the moist form the autolytic changes continue. A totally gan- 
grenous pulp presents a mass of debris in which lime concre- 
tions, fat droplets, crystals of fatty acids, crystals of hematoidin, 
crystals of triple phosphates, numerous bacteria, and various pig- 
ments are the only distinguishable elements. The fat droplets 
are partially produced by fatty degeneration of the myelin sheets 
of the nerve fibers and partially by disintegration of the cell pro- 
toplasm, which apparently contains fat as a metabolic constitu- 
ent in the form of lipoids. In the great majority of cases of pulp 
disintegration progressive moist gangrene is predominating. In 
clinical practice complete moist gangrene is not always found, 
and a pulp may be partially or totally gangrenous. In partial 
gangrene one part of the pulp may be totally putrescent, while the 
other part may be still in a state of severe inflammation. A fairly 
distinct line of demarcation may be observed between the dead 
and the inflamed part of the pulp. Through necrobiotic changes 
the entire pulp will finally become totally gangrenous. 

When dead protein material is subjected to the action of bacte- 
ria or ferments, the process is known as putrefaction. Putrefac- 
tion in its early stages is principally a process of hydrolysis and 
oxidation, and resembles closely tryptic digestion — that is, certain 
ferments, enzymes, and bacteria are concerned in the cleavage 
action of the protein molecule, a process which is closely allied 
to the changes occurring in the intestinal tract. The preliminary 
action of proteolytic enzymes on the dead protein molecule results 
in the formation of albumoses and peptons. The further decom- 
position of the peptons is productive of various amino ^tcids — -as 
fatty and aromatic acids — in which one of the hydrogen atoms 
has been replaced by a basic ammonia radical. It is claimed by 
Czapek and Emmerling that these amino acids furnish excellent 
nutrition for bacteria. The amino acids are further decom- 
posed by the elimination of ammonia and by the splitting off 
of carbon dioxid. In the ammonia elimination the end-products 
are found to consist of the free fatty acids corresponding to the 



144 PHARMACO-THERAPEUTICS. 

amino acids from which they are derived — as acetic, propionic, 
butyric, valerianic, caproic, and a-amino-valerianic acid — and of 
the aromatic acids — as phenyl-propionic, hydro-p-cumaric, ska- 
tol-acetic, and succinic acid. Sulphur is set free during the break- 
ing down of the protein substances; it partially unites with free 
hydrogen to form hydrogen sulphid, and partially with free CN 
groups to form various sulpho-cyanids of a less toxic character. 
The further oxidation of the various fatty acids results in the 
formation of many para-oxy acid compounds — as paracresol, 
phenol, etc. In the course of their decomposition the aromatic 
products furnish indol and skatol; indol finally combines with 
free sulphuric acid and forms indican. The latter substance fur- 
nishes an important diagnostic indicator of the progress of putre- 
faction. The aromatic and fatty acids, but especially skatol and 
indol, are largely responsible for the vile, fetid odor which accom- 
panies the putrefaction of protein material. The final end-prod- 
ucts are water, ammonia, hydrogen, hydrogen sulphid, and car- 
bon dioxid. This last stage of complete decomposition is rarely 
reached in the putrefaction of the pulp tissue. The reaction of 
the putrescent pulp is probably always alkaline, and the necessary 
carbohydrates which would furnish the acids by fermentation are 
absent. The acids that are formed during the decomposition of 
protein matter are readily neutralized by the many basic materials 
that are created simultaneously with the acids. It may be 
observed, however, that in the union of two amino acids an acid 
radical and a basic radical are left free, which, under certain con- 
ditions, gives rise to an amphoteric reaction. 

The bacterial phase of pulp decomposition is of even greater 
clinical significance than its chemistry. Hand in hand with the 
progress of chemic decomposition, the bacteria that are present 
in the pulp tissue give rise to many substances — as ptomains, tox- 
ins, endotoxins, and bacterial proteins. Moist gangrene results 
from the dual action of the proteolytic enzymes and putrefactive 
organisms. It is probably of little practical importance if we 
hold the bacillus pulpae pyogenes (Miller), the bacillus gangrene 
pulpaB (Arkovy), the bacillus putrificus cadaverus (Cook), or 
other organisms responsible for this condition. Sieberth and, very 



ANTISEPTICS. 145 

recently, Mayrhofer have shown that in moist gangrene and in 
pathologic disturbances resulting therefrom the many forms of 
streptococci are always present. The latter are "the bacilli which 
are usually associated with active forms of suppuration and 
sepsis." (McFarland.) Many other pathogenic bacteria, how- 
ever, as Poliakoff has shown, produce pus if placed in suitable 
surroundings. Mayrhofer 1 furnishes the following statistics con- 
cerning the presence of micro-organisms in dead pulp tissue. The 
infected material was obtained from 152 putrescent root canals, 
and, to verify the findings, the experiments were repeated in many 
cases. 

Number of times 
Organisms found. found. 

Streptococci 70 

Streptococci and rods 44 

Streptococci and staphylococci 14 

Streptococci, staphylococci, and rods 10 

Streptococci and yeast cells 5 

Streptococci, rods, and yeast cells 3 

Staphylococci 3 

Staphylococci and rods 1 

Rods 2 

Concerning the presence of these various micro-organisms in 
open and closed putrescent root canals, Mayrhofer obtained the 
following data : 

Number of times Number of times 

found in 53 cases of found in 51 cases of 
Organisms found. open root canals. closed root canals. 

Streptococci 27 31 

Staphylococci and rods 18 6 

Streptococci and staphylococci 3 1 

Streptococci, staphylococci, and rods. . 1 5 

Streptococci and yeast cells 1 

Staphylococci 1 2 

Staphylococci and rods 1 

Rods 1 6 

The influence of bacteria, per se, is of little importance as far as 
pathogenic disturbances are concerned, and the harm that is 
caused by the presence of these organisms is due to the many 
chemic products that result in one way or another from their 
metabolic processes. The many offensive products that accom- 

1 Mayrhofer: Principien der Pulpagangran, 1909. 



146 PHARMACO-THERAPEUTICS. 

pany putrefactive changes are attributed to anaerobic conditions, 
while in the presence of oxygen usually less ill-smelling com- 
pounds are formed. Some observers claim that only strictly anae- 
robic bacteria are concerned in the putrefaction of proteins. The 
streptococci and the staphylococci present in pulp gangrene are 
both : aerobic, and only optionally anaerobic organisms. The 
presence of the malodorous compounds is readily perceived by 
entering into a closed root canal containing a putrescent pulp. 

The poisonous chemic products of bacteria may, according to 
Wells, be conveniently divided into ptomains, toxins, endotoxins, 
and bacterial proteins. The ptomains — soluble basic nitrogenous 
substances resembling vegetable alkaloids — are found in the media 
in which bacteria grow. For some time it was believed that pto- 
mains were the cause of infectious disease, but it was soon found 
that they could be removed from cultures of pathogenic bacteria 
without destroying the poisonous nature of the latter. At present 
the chemistry of bacterial intoxication is more clearly worked out, 
and, as a consequence, ptomains . are of much less interest than 
they were twenty years ago. In decomposing protein material 
quite a large number of ptomains are more or less present as a 
result of the cleavage action of enzymes and other hydrolytic fac- 
tors. Cadaverin, putrescin, sepsin, muscarin, leucin, tyrosin, 
neuridin, etc., are some of the more important representatives of 
this interesting group. Ptomains do not act as specific poisons, 
but may produce diseases when taken into the body with food 
in w T hich they have been produced by bacterial activity. It is 
claimed that pathogenic bacteria present in living tissue can not 
produce sufficient ptomains to seriously affect the health of the 
individual. Moist gangrene of the pulp is a ready source of pto- 
main formation. » 

Certain pathogenic bacteria produce definite synthetic poisonous 
substances of a specific nature — the toxins. Toxins are the secre- 
tions of cells, and are readily taken up by the surrounding tissue. 
Toxins closely resemble enzymes, but their chemic composition 
is unknown at present; in fact, it is extremely doubtful if they 
can be produced in a pure state. Their intense poisonous nature 
is responsible for the chief symptoms which we recognize in 



ANTISEPTICS. 147 

infectious diseases. The bacillus of diphtheria and tetanus and 
the specific pus bacilli are known to secrete typical toxins. These 
toxins are always of the same poisonous nature, no matter how or 
where they are produced, while the ptomains vary with the nature 
of the substances from which they are produced. Toxins are very 
labile substances, and they are readily destroyed by heat, direct 
sun light, and oxygen. Antibodies or antitoxins can be prepared 
against toxins, but not against ptomains. As very few bacilli are 
known that produce specific toxins, it is plain why so few true 
antitoxins have been artificially prepared. 

Again, bacteria may produce poisons within their own cell 
bodies; they are not usually secreted by the cells, but are specific 
in their poisonous nature. These bodies are known as endotoxins. 
As yet no antitoxins have been prepared against endotoxins, and, 
as most bacterial diseases are caused by endotoxins, the prepara- 
tion of sera has been greatly retarded, and consequently immuni- 
zation against many infectious diseases is apparently impossible. 
Furthermore, bacteria contain poisonous materials which form an 
integral part of their protein constituents. These poisonous ma- 
terials are not soluble, and apparently do not produce diseased 
conditions. The bacterial substance itself may, however, produce 
inflammation and pus, or even necrosis, when injected into living 
tissues. These substances are called bacterial proteins. 

The formaldehyd-cresol mixture of Buckley consists of equal 
parts of formaldehyd and cresol, which, for the sake of con- 
venience, he has termed formocresol. Formaldehyd solution 
(U. S. P.) and cresol (U. S. P.) may be readily mixed in any pro- 
portion. If the formaldehyd solution is diluted Avith water prior 
to the addition of cresol, the latter will separate from the mixture. 
Fornlaldehyd develops its strongest antiseptic power when applied 
in vapor form on moist surfaces, but on dry material it is almost 
without action. At ordinary temperature it gives up vapors of 
formaldehyd and at body temperature this vaporization is in- 
creased. The vapors of formaldehyd are very penetrating, a 
factor that is of prime importance in the treatment of putrescent 
pulp. As a general deodorant, formaldehyd acts very weakly un- 
less it directlv combines with odoriferous substances to form new 



148 PHARMACO-THERAPEUTICS. 

compounds — as ammonia, hydrogen sulphid, etc. Cresol, com- 
mercially known as tricresol, is a mixture of metacresol, ortho- 
cresol, and paracresol; its most active component is metacresol. 
Cresol is about three times as active as phenol in antiseptic action, 
and about four times less poisonous to the animal organism. Cre- 
sol is a powerfully deodorizing medium, and acts on wound sur- 
faces, like all antiseptics of the benzol ring, as a slight anesthetic. 
Cresol and formaldehyd are both very highly reactive bodies, and 
it is very probable that some definite new compound arises from 
their union, which, in part at least, may help to explain the very 
gratifying results obtained with this mixture in the treatment of 
putrescent pulps. Compounds of cresol, or of phenol, and formal- 
dehyd have been recently prepared by manufacturing chemists 
(decillan, phenyform), and are used at present with apparent 
good success in the treatment of inoperable carcinoma of the 
uterus, e.tc. (Torggler.) Buckley makes the interesting state- 
ment, regarding the action of formocresol, that formaldehyd 
unites with hydrogen sulphid and ammonia to form inert com- 
pounds, and that with ammonia the nonirritating water-soluble 
hexamethylen (urotropin) is produced. Regarding the action of 
formaldehyd on a putrescent pulp, it should be remembered that 
its combination with the gases resulting from the decomposition of 
the pulp is of less importance to the future welfare of the tooth 
than its destructive action on bacteria and their products. As 
stated above, ammonia, hydrogen sulphid, and carbon dioxid are 
end-products of putrefaction, and consequently are not always 
met in every case, of death of the pulp that comes to us for treat- 
ment. These gases are absent in putrescent pulps that are found 
in open root canals. Buckley further states that cresol acts chem- 
ically on the fatty compounds, thereby disposing advantageously 
of these substances by saponifying the fats, which results in a 
compound somewhat similar to lysol. This statement, however, 
needs modification. Fats are insoluble in cresol or formaldehyd, 
or its combinations, and saponification can result only through 
the presence of an alkali. 1 Furthermore, cresol acts not merely 



1 Lysol is a compound that is closely related to the compound solution of cresol of the United 
States Pharmacopeia— a saponified mixture of cresol and linseed oil— and consequently no solu- 
tion of fats or formation of lysol-like compounds result from the action of cresol alone or 
when assisted by alcohol, as has been stated. 



ANTISEPTICS. 149 

as a diluent of the formaldehyd solution, and its very important 
function in the treatment of putrescent pulp is readily understood 
when we observe its chemic action on the products of protein de- 
composition. Cresol is the solvent of the vile-smelling fatty 
acids 1 — indol, skatol, and other products of enzyme action and 
bacterial metabolism. The very fact that paracresol and other 
similar compounds are some of the end-products of protein 
decomposition seems to point to the possibility that nature herself 
intended to arrest the process of putrefaction by creating certain 
antibodies. The destruction or removal of fats is of less impor- 
tance from a pathologic point of view, and is readily accomplished 
by mechanical or chemic means — as sodium dioxid, potassium 
hydroxid, kalium-n atrium alloy, etc. The slight coagulating 
properties of cresol have no significance in the presence of formal- 
dehyd, as the latter readily penetrates through coagulated albu- 
min. Regarding the action of antiseptics in general, it should 
be remembered that intimate contact with the organisms or their 
products is absolutely necessary to exercise their functions, and 
consequently not too much hope should be placed on the diffusi- 
bility of formaldehyd. Basing our hypothesis on the chemic 
reactions that occur when formocresol is brought in contact with 
a putrescent pulp, the following conclusions are obviously deduci- 
ble: Formaldehyd destroys bacteria and their products, and 
combines with certain gases, provided they are present, to form 
inert soluble compounds; cresol readily dissolves fatty acids and 
destroys ptomains, toxins, and other bacterial products, and modi- 
fies the caustic action of formaldehyd. Both chemicals are strong 
deodorizers, and their combined action increases the total power of 
their individual antiseptic activity. According to modern phar- 
macologic conception, a mixture of an antiseptic of the benzol 
series with an antiseptic of another kind is still more efficient 
than the corresponding proportion of either alone. (Cushny.) 

In the routine practice of treating putrescent pulps we depend 
almost solely on the absence of foul odors and on the discolora- 
tion of the cotton dressing as the diagnostic signs for a probably 
established asepsis. The true criterion for asepsis is, however, 



1 Williger: Deutsche Zahnarztliche Wochenschrift, 1907, p. 553. 



150 PHARMACO-THERAPEUTICS. 

found only in a bacteriologic test. Asepsis of an infected root 
canal can be temporarily established by applying chemic and 
mechanical measures, but sterilization of infected dentin in a 
tooth in situ is impossible. According to our present method of 
applying antiseptics, we can never reach the infected contents of 
the dentinal tubules, the deltoid foramina, or the many nidi 
of the ramified root canal. Miller has emphasized the fact that 
in the treatment of putrescent pulps we do not have to be alarmed 
about the presence of bacteria in the dentinal tubules, as exhaust- 
ing the pabulum keeps the micro-organisms in check. Recent 
experimental work conducted by Mayrhofer, Baumgartner, and 
others verifies the statement that bacteria and their spores are 
always present in the dentin of such teeth as have been, at one 
time or another, under antiseptic treatment. The lumen of the 
dentinal tubules varies from 1.3 to 3.2 /*, and the average size of 
a streptococcus is probably not much larger than 1 /*; hence the 
ready advance of the latter into the tubules. Even such powerful 
disinfectants as potassium hydroxid (Hattyasy), formocresol 
(Mayrhofer), or heat (Baumgartner) will not sterilize infected 
tooth substances. Filling of all the accessible parts of a root, canal 
with a nonputrefying material produces unfavorable conditions 
for the growth of bacteria: if the root filling itself is a persistent 
antiseptic and mummifying agent, the chances are more in favor 
of the permanency of our efforts. At any time, however, when 
the vitality of the individual becomes lowered and the natural 
bodies of defense present in the circulation are lessened, the filled 
tooth offers a place of minor resistance to the present restive forms 
of micro-organisms, and periapical disturbances follow, with the 
possibility of abscess formation. 

As far as clinical practice is concerned, the diagnosis of the 
conditions of a dead pulp is of little importance as regards the 
exact differentiation between the various forms of necrosis and 
gangrene. The routine treatment of a dead pulp is practically 
the same, except in those cases where only a partial necrosis of 
the pulp is present. To simplify matters, we will refer to a pulp 
that has died by accident as a gangrenous pulp, no matter in 
what state of decomposition the pulp tissue may be found. The 



ANTISEPTICS. 151 

treatment of the sequelae of the various forms of gangrene — peri- 
cementitis, alveolar abscess, etc. — has no bearing on our present 
consideration. The treatment of pulp gangrene necessarily di- 
vides itself into three definite phases: 

The antiseptic treatment. 

The chemic treatment. 

The mechanical treatment. 

To open into a tooth with a putrescent pulp does not require 
the adjustment of the rubber dam. and its presence has no influ- 
ence on existing conditions. Suitable napkins, cotton rolls, etc., 
properly applied, save much valuable time and unnecessary 
annoyance to the patient. The pulp chamber is opened as wide 
as possible, washed out, and as much as possible of the moisture 
of the canal is removed with aseptic paper canal points. A 




Figure 13. 
Aseptic Absorbent Paper Points. 

small pledget of cotton saturated with formocresol is now placed 
in intimate contact with the gangrenous mass and sealed into the 
canal by flowing a thin cement over the opening without pressure. 
If the pericementum is involved, it is better practice not to seal 
the tooth at the first consultation. The patient should return in 
two or three days, when the tooth is again opened, and an effort 
i- made to carefully remove the contents of the canal with suit- 
able broaches. Dipping the broach into formocresol at frecjuent 
intervals and wiping the gangrenous material on a piece of cotton 
cloth will be of great assistance in accomplishing the purpose. 
Extreme care should be exercised not to force the broach through 
the foramen, and all unnecessary manipulations in the canal 
should be avoided. The canal may now be washed out with hot 
water, alcohol, etc.. and a loose dressing, carrying formocresol. is 
placed in the canal. Small pieces of waxed floss silk or very thin 
catgut (the finest violin string), which are permanently kept in 



152 PHARMACO-THERAPEUTICS. 

the above mixture, are of great assistance in carrying the medica- 
ment to place. The second dressing should remain undisturbed 
for a few days. The condition of the canal at the next sitting 
will indicate further procedure. If a part of the pulp tissue 
should still possess vitality, the proper treatment depends on the 
stage of inflammation. Anesthetization or devitalization of the 
pulp stump may be indicated. If the conditions mentioned are- 
present in a multirooted tooth, a pledget of cotton saturated with 
formocresol is placed over the canal containing the putrescent 
pulp and sealed with cement, and the other pulp stumps are 
treated as previously outlined. As a final cleansing process, the 
use of sodium dioxid, as suggested by Kirk, in conjunction with 
50 percent sulphuric or hydrochloric acid, is now indicated 
Either of the acids is pumped into the canal, and then neutralized 
with sodium dioxid, carried on a broach moistened with alcohol, 
according to the following equations: 

H 2 S0 4 +Na 2 2 =Na 2 S0 4 +H 2 2 , 

or 2HCl+Na 2 6 2 =2NaCl+H 2 2 . 

The evolution of nascent oxygen is an important factor from 
the antiseptic viewpoint, and it will also assist in preserving the 
natural color of the tooth. Hydrated chloral in concentrated 
aqueous solution, with the addition of 10-percent hydrochloric 
acid, has been recently advocated by Baumgartner for the final 
cleansing of an infected root canal, and is apparently very useful 
for this purpose. After the final treatment the canal should be 
dried, and no time should be lost in filling it with the proper 
material indicated for the purpose. 

Alcopiol ; Alcohol, U. S. P. ; Spiritus Rectificatus, B. P. ; 
Refined Spirit; Ethyl Alcohol; Grain Alcohol; Spirit 
of Wine ; Alcool, F. ; Weingeist, G. 

Alcohol contains 92 percent by volume of ethyl alcohol. 
C 2 H 5 OH. The preparation of the British Pharmacopeia contains 
90 percent by volume. It is a transparent, colorless, mobile, and 
volatile fluid, having an agreeable odor and taste. An absolute 
alcohol containing not more than 1 percent by weight of water 



ANTISEPTICS. 153 

and the diluted alcohol containing 41 percent by weight of ethyl 
alcohol are also official. 

Alcohol, Methyllic; CH 3 OH. Wood alcohol, wood spirit, or 
naphtha. A product of destructive distillation of wood. It is a 
colorless, clear liquid, having a characteristic odor and taste. Tt 
is miscible in all proportions with water, alcohol, ether, etc., and 
boils at 150° F. (65° C). Wood alcohol is rarely employed for 
medicinal purposes, and its use as a substitute for grain alcohol 
is prohibited. Taken internally, or even inhaling its vapors, 
causes poisonous disturbances, usually resulting in blindness, etc. 

Ethyl alcohol possesses limited antiseptic power and precipi- 
tates albumin when applied to solutions containing at least 65- 
percent or more of pure alcohol. It possesses great affinity for 
water, and absorbs it freely from the living tissue cell, thereby 
acting as a mild caustic. The mucous linings of the mouth and 
stomach of man, being more or less continuously abused, have 
acquired a higher resistance to the action of alcohol, and are 
apparently not much damaged by alcoholic solutions as high as 
70 per cent. As an abortive treatment, alcohol indirectly possesses 
a beneficial influence on the early stages of abscess formation. 
When applied in the form of an alcohol pack or bandage, it irri- 
tates the deeper structures, thereby producing congestive hyper- 
emia, which, according to Bier, causes an increased bacteriolytic 
action of the blood — that is, the increased number of leucocytes 
(phagocytes) and the proteolytic action of the blood plasma act 
as antiseptics and absorbing agents. 

The antiseptic action of alcohol is most pronounced when 
applied in dilutions of 70 to 80 percent. Absolute alcohol pos- 
sesses only slight antiseptic power, which is probably due to the 
rapid coagulation of albumin of the cell wall, which prevents the 
further penetration of alcohol through this dense coagulated 
layer. It is also of importance to remember that water-soluble 
antiseptics lose much of their power when dissolved in or mixed 
with alcohol, while certain other antiseptics — as phenol, lysol, 
and thymol — act more powerfully when dissolved in 50-percent 
alcohol than when an equal quantity is dissolved only in water. 
Solutions of phenol in concentrated alcohol or in fatty oils are 



154 PHARMACO-THERAPEUTICS. 

comparatively worthless. The bactericidal action of alcohol is 
always materially increased when applied to moist surfaces. A 
70-percent alcohol solution in water will be about equivalent in its 
efficiency to a 3-percent phenol solution in water. Absolute alco- 
hol in connection with the warm air blast is effectively employed 
as a dehydrating agent of decalcified dentin. 

Buckley's Treatment for Pulp Gangrene. 

Cresol 1 part. 

Solution of f ormaldehyd 1 part. 

Root Canal Filling Material. 

powder. 

Thymol 5 parts. 

Exsiccated alum 10 parts. 

Kaolin 25 parts. 

LIQUID. 

Solution of formaldehyd 1 part. 

Cresol 2 parts. 

Alcohol 3 parts. 

Chloro-Percha and Formalin Root Filling. 

Gutta-percha base plate 10 parts. 

Chloroform 25 parts. 

Eucalyptol '. 15 parts. 

Thymol 2 parts. 

Paraf orm 1 part. 

Dissolve the gutta-percha in the chloroform. Dissolve the 
thymol in the eucalyptol, add the finely powdered paraform and 
shake well. Mix the two solutions, and keep the open bottle 
in a warm place until the chloroform has evaporated. 

Pulp Mummifying Paste. 

Paraform 1 part. 

Thymol. 1 part. 

Zinc oxid 2 parts. 

Glycerin enough to make a stiff paste. 






ANTISEPTICS. 155 

Scheuer's Rootfilling Paste. 

Zinc oxid 8 parts. 

Zinc sulphate, dehydrated 2 parts. 

Cresol 3 parts. 

Formaldehyd solution 1 part. 

Eugenol 1 part. 

Glycerin enough to make a stiff paste. 

Essential Oils, their Derivatives, and their Synthetic 

Substitutes. 

Essential, ethereal, volatile, or distilled oils, as they are vari- 
ously termed, are usually derived by distillation, sometimes by 
pressure, or maceration, from plants. The odor of the plant is 
primarily due to the presence of these oils. The oils are obtained 
from the fruit, the flowering part, the bark, or from the entire 
plant. Occasionally a plant may produce two different oils, like 
the juniper tree, or even three different oils, like the orange tree, 
in its various parts. The cryptogamic plants rarely produce essen- 
tial oils, the great bulk being obtained from the phenogamia, of 
which the following families are typical representatives : Birch, 
ginger, laurel, lily, myrtle, mustard, orange, parsley, pine, rue, 
sunflower, etc. The amount of oil obtained from the various 
plants differs widely, and may range from 0.1 to 20 percent, but 
most plants produce only small quantities. 

The oils are usually clear, colorless, sparkling fluids, which, 
by exposure, age, or the presence of some foreign matter, change 
to yellow, brown, red, or green. Some few oils possess a distinc- 
tive color — as, the oil of wormwood is dark brown (becoming 
green or bluish-green with age), and the oil of chamomile exhib- 
its a pale blue color. The stills or original metallic containers 
may impart a distinctive color to the oils — as, the green color of 
the oil of cajuput may be traced to the copper stills, or the copper 
canisters in which the oil is shipped. 1 

Essential oils are soluble in alcohol, ether, chloroform, fatty 
oils, etc. They are easily vaporized without decomposition, but 



1 Schimmel & Co. : Semi- Annual Reports, 1900-1908. 



156 PHARMACO-THERAPEUTICS. 

readily decompose with age and by absorbing oxygen; they 
become darker in color, and thick and viscid, depositing resinous 
precipitates. Agitated with water, they form a milky mixture, 
from which the oils soon separate, imparting their odor and taste 
to the water. Essential oils possess a strong odor and taste, and 
are used to a large extent in perfumery and medicine as flavoring 
agents. According to their medicinal properties, they are classed 
as diuretics, expectorants, stomachics, and purgatives, while den- 
tistry chiefly relies on their antiseptic, obtunding, and stimulat- 
ing qualities 

The volatile oils do not belong to a definite chemic group, 
and are consequently extremely difficult to classify. Most of the 
oils are composed of hydrocarbons, represented by various modi- 
fications of the general formula known as terpenes, C 5 H 8 -n ; 
or composed of oxygenated aromatic bodies, as alcohols of the 
fatty series, aldehyds, acids, ketons, phenols, esters, etc. ; or 
they may represent a mixture of the terpenes with one or more 
of the other bodies. 1 The terpenes do not necessarily carry the 
odorous principle of the oils, as was formerly supposed; by frac- 
tional distillation the terpenes may be removed entirely, and the 
oils are thus very highly concentrated. Recently organic chem- 
istry has succeeded in producing by synthesis quite a number of 
these odoriferous principles — as methyl salicylate, geraniol, arti- 
ficial oil of roses, heliotropin, cumarin, etc. Halogen derivatives 
have thus far not been isolated from essential oils. Certain oils 
deposit on standing, or when exposed to lower temperature, a solid 
crystalline substance known as stearopten or camphor, while the 
remaining fluid is termed eleopten. 2 A few oils contain nitroge- 
nous bodies in the form of cyanogen compounds (oil of bitter 
almonds) and of sulphur compounds (volatile oil of mustard). 
Volatile oils differ from fixed or fatty oils in so far as they do not 
form glycerites (soap) when treated with -alkalies; they do not 
decompose by heat, and their stain on paper is readily volatilized. 
The essential oils differ very widely in their antiseptic power. 
The latter depends largely on their volatility, which, according 



1 Parry: Chemistry of Essential Oils and Perfumery, 1894. 

2 Powers: Essential Oils and Organic Chemic Preparations, 1894. 



ANTISEPTICS. 157 

to Cushny, "enables them to penetrate readily into protoplasm, 
and lessens its vitality by acting as foreign bodies (molecular irri- 
tants) ; in addition, they are nearly related to the benzol series, 
the members of which are all antiseptics and protoplasm poison." 
They also possess anesthetic properties. When applied to the 
skin or mucous membrane, the volatile oils act as strong irritants. 
This irritating property of the oils results most likely from the 
presence of the terpenes, which, like other volatile substances, are 
more or less prone to produce redness and itching. It has, how- 
ever, been repeatedly shown that this irritating property of the 
oils on the higher tissue cells is much more pronounced than on 
the lower -forms of life, as they penetrate the cell walls of the 
higher organisms much more rapidly than those of the bacterial 
cells. Administered internally in well-diluted form, they pro- 
duce a feeling of warmth, and may give rise to an increased appe- 
tite. Aside from their physical properties, the oils may act also 
by virtue of their chemic nature. The explanation of this phar- 
macologic phenomenon is at present unknown — that is, we do not 
know why certain oils (volatile oil of mustard) produce such vio- 
lent irritation, and others (oil of cloves) possess pronounced local 
anesthetic properties. As has been experimentally shown by 
Fischer, certain essential oils — oils of cloves, peppermint, euca- 
lyptus, cassia, etc. — produce severe irritation, and, if the applica- 
tion is continued, cause atrophy of the pulp. It is apparently 
immaterial whether the oils are applied directly on the pulp or 
indirectly on the dentin. The obtundent properties of certain 
essential oils which Liebreich has classified as painful anesthetics 
manifest themselves at first by severe irritation, which is followed 
by pronounced anesthesia. This primary severe irritation of the 
delicate pulp tissue is frequently the cause of its final death, a 
factor which should be remembered in the conservative treatment 
of this organ. 

Some of the essential oils of the family myrtacese — as oil of 
eucalyptus, oil of cajuput, oil of myrtle, etc. — possess the addi- 
tional property of dissolving gutta-percha. This property is 
attributed to cineol, the active constituent of -these oils. 

At present the medicinal value of the essential oils is graded 



158 PHARMACO-THERAPEUTICS. 

according to the amount of active constituents which they con- 
tain — as, oil of cinnamon should contain at least 75 percent of 
cinnamic aldehyd, etc. 1 Essential oils have been and are still 
quite frequently sophisticated with cheaper substitutes. The fol- 
lowing statement (1908), made by a prominent distiller in the 
United States, helps to verify this fact in regard to at least one oil : 

"The actual production of true wintergreen leaf oil amounts to 
only an infinitesimal fraction of the enormously increased demand 
for the article (or for an oil so labeled) under the Food and 
Drugs Act. We are unable to procure enough of it to fill one 
percent of the orders that come to us, and of even that one percent 
the authenticity could not be absolutely established. We have 
therefore preferred not to attempt to handle the article at all ; and 
we make this statement merely to inform hundreds of corre- 
spondents, to whom the facts stated have been privately com- 
municated before, that our position remains, and is likely to 
continue indefinitely to remain, unchanged." 

The methods for the detection of these adulterations have been 
much improved within the last decade. 2 Volatile oils should be 
kept in well-stoppered amber-colored bottles in a dark, cool, and 
dry place, as the effect of heat and sunlight may spoil the best 
oils within a few weeks. 

The value of essential oils as dental antiseptics is largely over- 
estimated, as has been repeatedly shown by careful experiments 
made by Miller, Cook, MaWhinney, and others. The late Miller 3 
especially expressed himself very definitely on this particular 
point as follows: 

"According to my own views it would be a misfortune for 
dentistry in its entirety if the endeavor to replace carbolic acid 
by the essential oils should succeed. Personally, I am convinced 
of the eminent antiseptic power of oil of cassia especially. In the 
last few years I have made experiments with this particular oil 
in treating diseased teeth. Lately I have again abandoned it, as 
in many cases where I formerly obtained good results with car- 
bolic acid I did not succeed with oil of cassia. Also in many other 



1 Charabot, Dupont et Pilet: Les Huiles Essentialles, 1900. 

2 Gildemeister and Hoffmann: The Essential Oils, 1900. 

3 Miller: Die Mikroorganismen der Mundhohle, 1892, p. 224. 



ANTISEPTICS. 159 

cases, especially in pronounced apical root irritation as a result 
of gangrene, where the treatment with oil of cassia was a failure 
I have occasionally obtained a cure in a short time with car- 
bolic acid. I feel certain that I have used the oil of cassia 
conscientiously, and in the beginning I had even a special liking 
for this medicament." 

In the present routine practice of conservative dentistry very 
few essential oils are utilized, but these oils should be of the best 
quality. Better results are obtained from the application of their 
essential chemic constituents — eugenol instead of oil of cloves, 
cinnamic aldehyd instead of oil of cassia, eucalyptol instead of 
oil of eucalyptus, methyl salicylate instead of oil of wintergreen, 
etc. We particularly emphasize what we have already stated 
(page 37) in regard to dental drug purchases — they should be the 
product of a reliable manufacturer and purchased only in original 
packages. 

MaWhinney 1 has recorded a series of experiments relative to 
the antiseptic value of the essential oils and other drugs, of which 
the following is an abstract : 

"The culture medium used in my experiments was nutrient 
beef bouillon, carefully made and sterilized according to the 
usual methods. The organisms used were fresh, pure cultures 
of the staphylococcus, except when othenvise indicated. The rea- 
son for using pure cultures were: (1) To obtain specific action on 
the bacteria; (2) mixed cultures of bacteria and their products 
so act upon each other as to lessen their resisting power to chemic 
agents. The reason for using the staphylococcus was that it 
is the organism with which the dentists have to deal most fre- 
quently. The organisms were distributed carefully throughout 
a tube containing 10 cubic centimeters of nutrient beef bouillon 
(examination made to see that colonies were broken up and thor- 
oughly distributed) . A loopful of this was transferred to each 
tube containing 10 cubic centimeters of the medium, into which 
the medicament was distributed carefully, weighing the amount 
used. This was then placed in the incubator and kept at 37° C, 
and examined from time to time." 



1 MaWhinney: Transactions Illinois State Dental Society, 1900, p. 125. 



160 



PHARMACO-THERAPEUTICS. 



From the various tables accompanying MaWhinney's articles 
the following have been selected on account of their complete- 
ness : 

DETERMINATION OF THE STRENGTH OF THE ANTISEPTICS. 



Medicament used 



Amount of 

medicament 

used 



Oil cassia 

Oil cinnamon 

Oil peppermint 

Oil cloves 

Oil cajuput 

Black's 1-2-3 

Oil wintergreen 

Oil eucalyptus 

Oil cedar 

Oil cade 

Oil birch tar 

Phenol, melted crystals . . . 
Creosote, pure beechwood 

Campho-phenique 

Control tube 

Creolin 

Trikresol 

Chinosol, 10-percent sol. . . 



VA minims 

1% '.' 

VA " 

VA " 

VA " 

VA " 

VA " 

1% " 

VA " 

1% " 

VA " 

VA " 

1% " 

VA " 



Condition in 
24 hours 



Condition in 
96 hours 



minim 

< < 

minims 



Growth 

< < 

Slight growth 

< i < < 

<< « < 

< < it 

Growth 

« « 

Slight growth 



Growth 
No growth 



1 Marked growth 



2 Growth 
i << 



3 Marked growth 
3 Growth 



Slight growth 



3 Growth 

3 " 

3 Good growth 

3 Very marked growth 

3 No growth 



To determine the strength of an antiseptic in the manner pre- 
viously mentioned (page 77) is by no means sufficient to estab- 
lish the fact that it is either weak or strong. Painstaking tests 
and laborious records in regard to the time of the exposure of the 
germs, number of germs, culture media, temperature, etc., are 
essential factors to obtain a fair amount of tangible material for 
comparison. The obtained results are, it should be remembered, 
only laboratory experiments, and the deductions drawn should 
not be transferred at once to active practice, for here we meet with 
many conditions which may lead to totally erroneous conclusions 
in regard to the real value of the employed antiseptic if these new 
surroundings are not carefully taken into consideration. For this 
very reason it is not surprising that so many contradictory state- 
ments are made as to the merit of any particular antiseptics. 



1 Oil in bottom of tube. 

2 Oil on top of broth. 

3 Soluble still. 



ANTISEPTICS. 



161 



In the following table "the germicidal power of the medica- 
ments is determined by the time necessary to expose germs to it, 
and, as will be seen, a great difference appears. It will be noticed 
that some agents were used in full strength and others in percent 
solutions, according as they could be used in practice. The germs 
used were mixed pus cultures." 

DETERMINATION OF THE TIME REQUIRED FOR ANTISEPTIC ACTION. 



Agent 


Percent solution 


Time required, 
minutes 


Oil cloves 


Full strength 
< < <« 

a a 
a << 
«< a 
it it 
a tt 
a tt 
a it 
a a 
tt it 
a a 
a tt 

1:1,000 

Full strength 

a a 

1:250 

Full strength 
tt a 

10 percent 

Full strength 

Saturated alcoholic solution 

tt a a 


40 
40 
40 


Oil cajuput 

Oil eucalyptus 

Oil wintergreen 

Oil peppermint 


45 
40 
60 
50 


Oil cade 


25 


Oil birch tar 


20 


Oil pennyroyal 

Phenol 

Creosote, beechwood 

Campho-phenique 

Mercury bichlorid 

Creolin 

Sublamin 

Kresamin 

Formalin 

Chinosol 

Tribromophenol 

Trichlorphenol 


45 

30 

30 

40 

25 

5 

5 

3 

5 

2 

1 

5 

10 

8 



The following table, by Miller, 1 indicates the concentration in 
which the various oils can be used in the mouth: 



Oil cloves 1 : 550 

Oil eucalyptus 1 : 750 

Oil peppermint 1 : 600 

Oil pinus pumillio 1 : 360 



Oil cinnamon 1:400 

Oil wintergreen 1 : 350 

Eugenol 1:750 

Thymol 1:2,000 



For obvious reasons, only those oils, their derivatives, and syn- 
thetic substitutes that have a direct relationship to the practice 
of dentistry are considered. 



1 Miller: Die Mikroorganismen der Mundhohle, 1892, p. 223. 




162 PHARMACO-THERAPEUTICS. 

Essential Oils. 

Oil of Betula (Oleum Betul^e, U. S. P.). — Oil of sweet 
birch ; essence de bouleau, F. ; Birkenrindenol, G. A volatile oil 
obtained from the bark of sweet birch. Betula lenta Linne (nat. 
ord. Betulacese) . It is a colorless or yellowish liquid, having a 
characteristic, strongly aromatic odor and taste, closely resem- 
bling that of oil of wintergreen. This oil is identical with methyl 
salicylate, and equally identical with oil of wintergreen, for 
which it is frequently substituted. Average dose, 15 minims 
(lCc). 

Oil of Cajuput (Oleum Cajuputi, U. S. P., B. P.). — Oil 
of white wood, essence de cajeput, F. ; Cajeputol, G. A volatile 
oil distilled from the leaves and twigs of Melaleuca leucadendron 
Linne (nat. ord. Myrtacese) . The oil of cajuput is very fluid and 
transparent. Usually it has a fine green color, and an agreeable, 
distinctly camphoraceous odor. Its active constituent is cineol 
(cajuputol), a chemic body of w T hich it should contain at least 
55 percent, and which is identical with eucalyptol. Oil of cajuput 
is used as a carminative, stimulant, diaphoretic: and counter- 
irritant. Average dose, 8 minims (0.5 Cc). 

Oil of Caraway (Oleum Carl, U. S. P., B. P.). — Essence de 
carvi, F. ; Ktimmelol, G. A volatile oil distilled from caraway, 
Carum carvi Linne (nat. ord. Umbelliferse) . The oil of caraway 
is somewhat viscid, of a pale, yellowish color, becoming brownish 
by age, and with an odor of the fruit caraway. Its active con- 
stituent is carvacol (carven) ; it is identical with carvol, the 
active constituent of the oil of dill. It resembles the oil of cloves 
in its antiseptic and anodyne action, and is also largely used as a 
carminative. Average dose, 3 minims (0.2 'Cc). 

Oil of Cinnamon; Oil of Cassia (Oleum Cinnamomi, U. S. 
P., B. P.). — Essence de cannelle, F. ; Zimmtol, G. A volatile 
oil distilled from cassia-cinnamon, which is from one or more 
undetermined species of cinnamon grown in China (nat. ord. 
Laurinese). Two oils of cinnamon are found in commerce — one 
procured from the Ceylon cinnamon, the other from the Chinese 
cinnamon. The latter is often distinguished by the name of oil 



ANTISEPTICS. 163 

of cassia. There is no essential difference between the two oils. 
The Chinese oil is much cheaper and more abundant, although 
not so fine in flavor as the Ceylon product. It is a yellowish or 
brownish liquid, becoming darker and thicker with age and 
exposure to the air, having the characteristic odor of cinnamon, 
and a sweetish, spicy, and burning taste. The medicinal proper- 
ties of cinnamon oil depend solely on the amount of cinnamic 
aldehyd present. A good oil should contain at least 75 percent 
of cinnamic aldehyd. The latter, by moderate oxidation, forms 
cinnamic acid, but, by more energetic action, benzoic acid is pro- 
duced. Quite a number of other chemic bodies — as eugenol, 
pinen, etc. — have been isolated from this oil. They are, how- 
ever, present only in very small quantities. Cinnamon oil is 
used principally as a flavoring agent, and in dentistry as an anti- 
septic. It possesses carminative and stimulating qualities. Of 
all the essential oils, oil of cinnamon is the one which has received 
the highest praise as an antiseptic for the treatment of putrescent 
root canals, and some practitioners have gone even so far as to 
place its comparative antiseptic power above that of phenol. This 
praise is partially the result of erroneous clinical observations and 
partly of empirical conclusions. The late Miller expressed him- 
self very distinctly on this particular point. (See page 158.) Oil 
of cinnamon, like most of the essential oils, penetrates the tooth 
structure very readily, usually discoloring the tooth to a yellowish- 
brown hue, resulting from the deposition of a resinous substance, 
furfural, in its tubules. Harlan claims that ozonized oil of tur- 
pentine will remove such stains from the teeth. If oil of cin- 
namon is used at all for the treatment of devitalized teeth, the 
synthetic oil, or Merck's "two-fold, free from terpene, oil of 
cassia/' should be employed. Average dose, 1 minim (0.05 Cc). 
Oil of Cloves (Oleum Caryophylli, U. S. P., B. P.). — Es- 
sence de giroffle, F. ; Nelkengl, G. A volatile oil distilled from 
cloves, Eugenia aromatica Linne (nat. ord. Myrtacess) . Oil of 
cloves, when recently distilled, is very fluid, clear, and colorless, 
but becomes yellowish, and finally reddish-brown and thick with 
age. Its medicinal properties depend on the presence of eugenol, 
a monatomic phenol, of which a good oil should contain at least 



164 PHARMACO-THERAPEUTICS. 

80 percent. The value of quite a number of other oils also 
depends chiefly on the presence of eugenol — as cinnamon leaf oil, 
oil of bay, oil of pimenta, etc. Oil of cloves enjoys an old and 
well-earned reputation of being a valuable obtunding remedy in 
the treatment of toothache arising from an irritated pulp. It 
also possesses stimulating and antiemetic properties. Average 
dose, 3 minims (0.2 Cc). 

Oil of Eucalyptus (Oleum Eucalypti, U. S. P., B. P.). — 
Essence de eucalyptus, F. ; Eucalyptusol, G. A volatile oil dis- 
tilled from the fresh leaves of eucalyptus (nat. ord. Myrtacese) . 
Oil of eucalyptus is a colorless or pale yellow liquid, with a char- 
acteristic, aromatic, and somewhat camphoraceous odor, having 
a pungent, spicy, and cooling taste. The value of this oil depends 
on the amount of eucalyptol (cineol) present, of which it should 
contain at least 50 percent. Average dose, 8 minims (0.5 Cc). 

Oil of Gaultheria (Oleum Gaultherle, U. S. P.). — Oil of 
wintergreen; oil of tea berry; oil of partridge berry; Winter- 
greenol, G. A volatile oil distilled from the leaves of Gaultheria 
procumbens (nat. ord. Ericaceae) . It consists almost entirely of 
methyl salicylate, and is nearly identical with the volatile oil of 
betula (sweet birch). Wintergreen oil possesses little value as 
an antiseptic. It is used as a substitute for salicylic acid in its 
internal administration. It is slightly stimulating and astringent 
in its effect, and is much in favor as a flavoring agent for mouth 
specialties — as dentifrices, cachous, chewdng gums, etc. Average 
dose, 15 minims (1 Cc). 

Oil of Mustard, Volatile (Oleum Sinapis Volatile, 
U. S. P.). Volatile oil of mustard; essence de moutarde, F. ; 
atherisches Senfol, G. A volatile oil obtained from black mus- 
tard, the seed of Brassica nigra, by maceration with water and sub- 
sequent distillation. It is a very powerful irritant, and its use is 
limited to external application in alcoholic solutions. It is the 
active agent of the mustard plaster. It is said to be of assistance 
in the removal of the odor of iodoform from the hands, etc. 
Average dose, 1 / 8 minim (0.008 Cc). 

Oil of Myrcia (Oleum Myrcle). — Oil of bay; essence de 
bay, F. ; Bayol, G. A volatile oil distilled from Myrcia acris 



ANTISEPTICS. 165 

(nat. ord. Myrtacese) . This oil resembles very closely the oil of 
pimenta and oil of cloves. Its medicinal value depends on the 
amount of eugenol present. On account of its fragrance it is 
largely used as a perfume and as an ingredient in the preparation 
of bay rum. 

Oil of Peppermint (Oleum Mentble Piperita, U. S. P., 
B. P.). Essence de menthe poivree, F. ; Pfefferminzol, G. A 
volatile oil distilled from peppermint, Mentha piperita (nat. ord. 
Labiatse) . The oil of peppermint is colorless, or of a light green- 
ish-yellow color, which becomes reddish by age. Its odor is 
strong and aromatic. Its taste is warm, camphoraceous, and very 
pungent, but succeeded, when air is admitted into the mouth, by 
a sense of coolness. The medicinal properties of this oil depend 
on the menthol present, of which it should yield 50 percent. Oil 
of peppermint is stimulating and carminative, and is largely used 
as an external remedy in facial and other neuralgic pain. On 
account of its odor it is rarely employed as an antiseptic, but is 
much used as a flavoring agent for oral specialties. Average 
dose, 3 minims (0.2 Cc). 

Oil of Thyme (Oleum Thymi, U. S. P.). — Essence de thyme, 
F. ; Thymianol, G. A volatile oil distilled from the leaves and 
flowering tops of Thymus vulgaris (nat. ord. Labiatse). Drug- 
gists list two varieties of this oil, the white and the red, the white 
oil being a purified product of the crude red oil. Often a crude 
oil is imported from France under the name of oil of thyme that 
is oil of origanum (wild marjoram) . The medicinal properties of 
oil of thyme depend on the thymol present, of which it should 
yield not less than 20 percent. The oil is used as an antiseptic 
and irritant in external applications. Average dose, 3 minims 
(0.2 Cc). 

Oil of Ylang Ylang (Oleum Cananga). — Oil of ylang 
ylang is distilled in Manila from the flowers of Cananga odorata 
(nat. ord. Anonacese) . This oil is especially noted for its delicious 
perfume. It seems to be a complex mixture, and the following 
bodies have been found in the oil : The esters of benzoic and sali- 
cylic acids, eugenol, iso-eugenol, geraniol, pinen, small quanti- 
ties of paracresol, etc. In a recent communication to the Fourth 



166 PHARMACO-THERAPEUTICS. 

International Dental Congress (St. Louis, 1904), Ottofy, of Ma- 
nila, P. I., speaks very highly of the antiseptic and obtunding 
qualities of this oil, claiming that it is superior in its medicinal 
virtues to all the other essential oils that he has used in his prac- 
tice. Oil of cananga is a less fragrant oil of ylang ylang, pre- 
pared^ from the same plant in Java. 

Derivatives and Synthetic Substitutes of Essential Oils. 

Borneol. — Artificial blumea camphor of the Chinese; Borneo 
camphor ; borneol, F. ; Borneol, G. A colorless, crystalline sub- 
stance, having an odor quite different from that of ordinary cam- 
phor, resembling somewhat the odor of patchouly or ambergris. 
It is readily soluble in alcohol, chloroform, etc., but insoluble in 
water. It possesses antiseptic properties. 

Camphor; Camphor, U. S. P., B. P.; C 10 H 16 O. — Camphre, F. ; 
Kampher, G. Camphor is a stearopten obtained from Cinnamo- 
mum camphora. It forms white, translucent, crystalline masses, 
which are almost insoluble in water, but dissolve readily in alco- 
hol, ether, chloroform, and in fixed and volatile oils. It is incom- 
patible with phenol, thymol, hydrated chloral, menthol, resor- 
cinol, etc., in dry triturations, and liquefies these substances when 
brought in contact therewith. Average dose, 2 grains (0.125 
Gm.). 

Therapeutics. — On the skin and mucous membrane camphor 
acts as a mild irritant. It produces redness and a feeling of 
warmth when rubbed into the skin, and is principally applied 
externally in the form of alcoholic solutions or as a liniment 
(camphorated oil). It possesses slight antiseptic action, and is 
frequently used to modify the caustic action of phenol, thymol, 
resorcinol, etc. Internally it is used as a stimulant of the central 
nervous system, and is especially indicated in collapse arising 
from the action of general anesthetics, or from depression and 
weakness. In such cases it acts as an analeptic by increasing the 
heart action. It is usually injected hypodermically in sterilized 
solutions of olive oil. 

Carvol. — Carvole, F. ; Carvol, G. A keton forming the essen- 
tial constituent of the oil of caraway seed and oil of dill. It 



ANTISEPTICS. 167 

is a pale yellow liquid, having the fine odor of caraway seed. It 
is used as a substitute for the oil of caraway and oil of dill. 

Cinnamic Aldehyd; Cinnaldehydum, U. S. P. — Aldehyde 
cinnamique, F. ; Zimmtaldehyd, G. An aldehyd obtained from 
oil of cinnamon, or prepared synthetically. It should contain 
at least 95 percent of pure cinnamic aldehyd. It is a colorless 
liquid, having a cinnamon-like odor and a burning, aromatic 
taste. It is sparingly soluble in water, soluble in all proportions 
in alcohol, ether, and fixed and volatile oils. It is largely used 
as a substitute for the various oils of cinnamon in the treatment 
of putrescent root canals. Cinnamic aldehyd will not discolor- 
tooth substance, which is frequently observed when oil of cassia 
is used. Average dose, 1 minim (0.05 Cc.) . 

Eucalyptol; Eucalyptol, U. S. P.; C 10 H 18 O. — Cineol, caju- 
putol, eucalyptus camphor; eucalyptol, F., G. A neutral body 
obtained from the volatile oils of Eucalyptus globulus and from 
various other sources. It is a colorless liquid, congeals below 
32° F. (0° C), having a camphor-like odor and a pungent, 
spicy, and cooling taste. It is identical with cajuputol and 
cineol. It is soluble in alcohol, ether, chloroform, etc., but in- 
soluble in water. It is antiseptic, antispasmodic, expectorant, 
and antiperiodic ; in combination with menthol and other bodies 
of a similar nature it is much in favor as an inhalent or 
as a spray diluted with a bland oil in bronchitis, asthma, pneu- 
monia, rhinitis. It does not possess anesthetic properties. Aver- 
age dose, 5 minims (0.3 Cc). 

Therapeutics. — Eucalyptol is practically nonirritant. In con- 
nection with cotton it is a valuable agent for the temporary filling 
of such root canals as require observation. As a lubricant for 
gutta-percha cones for the filling of root canals it is to be recom- 
mended. Eucalyptol will dissolve gutta-percha, If a perfect 
solution is desired, the gutta-percha should be first dissolved in 
chloroform, and then an equal amount of eucalyptol added, the 
bottle being left open until the chloroform is evaporated. This 
solution is superior to the so-called chloro-percha — a solution of 
gutta-percha in chloroform. (See Protectives, Demulcents, and 
Emollients.) 



168 PHARMACO-THERAPEUTICS. 

Modified Eucalyptol. 

fy Menthol. gr. ij (0.12 Gm.) 

Thymol. gr. iij . (0. 15 Gm. ) 

Eucalyptol. 3 j (4 Cc.) 

M. 
Sig. : To be used in infected root canals. 

(Buckley. ) 

Eugenol; Eugenol, U. S. P.; C 10 H 12 O 2 . — Eugenic acid, cary- 
ophylic acid; eugenol, F., G. An unsaturated, aromatic phenol, 
obtained from oil of cloves and other essential oils. A color- 
less or pale yellow liquid, highly refractive, becoming brown 
on exposure to air, and having a strong aromatic odor of cloves 
and a pungent, spicy taste. It is soluble in alcohol, ether, 
chloroform, and diluted solutions of caustic soda; insoluble in 
water. It possesses antiseptic, stimulating, and local anesthetic 
properties. It is largely used as a substitute for oil of cloves. 
Average dose, 3 minims (0.2 Cc). 

Therapeutics. — Eugenol is equally as strong an antiseptic as 
phenol, possessing decidedly less cauterant properties. It is an 
excellent anesthetic for the treatment of pain arising from an 
irritated Or diseased pulp, either alone or in combination with 
other suitable remedies. In the form of a paste it is recommended 
as a means of capping the exposed pulp or as a temporary filling 
in hypersensitive cavities. In preparing such temporary cements, 
rather large quantities of eugenol must be incorporated into the 
powder. Combined with formaldehyd solution, it is recom- 
mended for the treatment of putrescent pulps. To isolate the 
strong anesthetic properties from eugenol, as the latter still acts 
as a mild cauterant, a number of compounds have been prepared 
synthetically, among which the p-amino -ben zoic acid has been 
found to be of the utmost importance. If this acid is combined 
with certain esters, it furnishes the basis on which some of the 
most important local anesthetics have been constructed. Com- 
bined with ethyl ester, it fo^ms anesthesin, and, in another modi- 
fication, orthoform, while the hydrochlorid of its di-ethyl-amino- 
ethanol ester is known as novocain. The simple p-amino-benzoyl 
eugenol, which is also a strong anesthetic and antiseptic, has 
received many laudable recommendations from German dentists. 



ANTISEPTICS. 169 

It appears in slightly yellowish or white prisms, which are readily 
soluble in alcohol and ether, but insoluble in water. In the form 
of a temporary cement, known as a plecavol, it is employed as 
a temporary filling in painful conditions of the pulp arising from 
dental caries, and as a root filling material. 

Pulp Capping Paste. 

Aristol or europhen 1 part. 

Calcium phosphate 10 parts. 

Eugenol enough to make a creamy paste. 

Menthol; Menthol, U. S. P., B. P. — Camphore de menthe, 
F. ; Pfefferminzkampfer, G. A stearopten (camphor), having 
the character of a saturated secondary alcohol, C 10 H 19 OH, ob- 
tained from the official or from the Chinese or Japanese oil of 
peppermint. Japanese menthol appears in colorless crystals or 
in fused crystalline masses, having a strong odor of peppermint 
and a warm, aromatic taste, followed by a sensation of cold when 
air is drawn into the mouth. It melts at about 110° F. (43° 
C). It is slightly soluble in water, but freety soluble in alcohol, 
ether, chloroform, etc. It possesses antiseptic, anesthetic, and 
analgesic properties. Menthol in the shape of compressed cones 
or combined in an ointment is largely employed for the relief of 
neuralgic pains. When applied to the skin, it produces at first 
slight pain, with a sensation of cold and benumbing the skin. It 
is largely used as a substitute for oil of peppermint. 

Methyl Salicylate. — Artificial or synthetic oil of winter- 
green ; salicylate de methyl, F. ; Kiinstliches Wintergreenol, G. 
A colorless or slightly yellowish liquid, having a characteristic, 
strong aromatic odor and a sweetish, warm taste. It is at present 
almost universally used as a substitute for the natural oil of win- 
tergreen or oil of sweet birch. 

Myrtol. — A compound prepared by the fractional distillation 
of oil of myrtle, consisting largely of cineol, and therefore almost 
identical with eucalyptol and cajuputol. It is used as a substitute 
for oil of myrtle. 

Thymol; Thymol, U. S. P., B. P. — Thymic acid, thyme cam- 
phor, methylnormalpropylphenol ; acide thymique, F. ; Thymol, G. 



170 PHARMACO-THERAPEUTICS. 

Thymol is a phenol of the benzol series, C 10 H 14 0, occurring 
in the volatile oil of Thymus vulgaris and other volatile oils. It 
appears in colorless, crystalline masses, having an aromatic, pun- 
gent, and slightly caustic taste, and is of nearly neutral reaction. 
It is practically nontoxic. It melts at about 225° F. (107° C), 
is slightly soluble in water (1:1,000), but very readily soluble in 
alcohol, ether, essential and fatty oils, chloroform, glacial acetic 
acid, etc. When treated with camphor, menthol, chloral, etc., 
it liquefies. In its local action it closely resembles phenol and 
salicylic acid. It is not as caustic as phenol, but more destructive 
to putrefactive substances. 

Therapeutics. — Thymol received its first attention by M. Bouil- 
lon, *a French pharmacist, and soon after it was introduced into 
general medicine (1876). Thymol has been highly recom- 
mended by dental practitioners, and its valuable antiseptic prop- 
erties have been sustained. In combination with other similar 
remedies, it is to be recommended on account of its persistent 
action. A saturated alcoholic solution of thymol is recommended 
by Hirsch as a specific for the treatment of chronic alveolar ab- 
scesses. Its irritating nature prohibits its use in acute pericemen- 
titis. The following solution, known as thymocamphene, has 
given universal satisfaction for the treatment of putrescent root 
canals : 

Thymol 4 parts. 

Phenol 4 parts. 

Camphor 2 parts. 

Place the drugs in a dry amber-colored bottle. They will soon 
liquefy and remain liquid. 

Kohler recommends the following combination for the above 

purpose : , 

Thymol 1 part. 

Mono-chloro-phenol 3 parts. 

Potassium hydroxid 1 part. 

Dissolve the thymol, placed in a dry test tube, in the lique- 
fied mono-chloro-phenol and add to the solution the potassium 
hydroxid. Carefully heat over a low Bunsen flame until a per- 
fect solution is produced. Immediately transfer to small, per- 
fectly dry bottles, which should be protected by a paraffin 
stopper. 



ASTRINGENTS. 171 

To Miller belongs the credit of first recommending thymol in 
combination with other chemicals as a medicament for the mum- 
mifying of pulp tissue. In alcoholic solution it is much lauded 
as a mouth wash. 

Thymotal. — According to Pool it is a tasteless derivative of 
thymol for internal administration. It is soluble in alkaline 
media only. 

ASTRINGENTS. 

Astringents (from stringer e, to bind) are substances which, 
when brought in contact with a wound or a mucous surface, cause 
the formation of a thin, skin-like protective film. The film results 
from: 

1. The drying up and combining of the astringent with the 
secretions. 

2. The coagulation of fibrogenous substances. 

3. The precipitation of albuminous substances. 

4. The chemic change of the tissue known as "tanning." 

The term astringent is usually interpreted as drawing together. 
While all astringents possess in a more or less marked degree this 
peculiar property so easily recognizable by the taste, and, if 
applied in concentrated solution, by the naked eye, it should be 
remembered that it is only a symptom of the astringent action 
as a whole. If astringents are applied in concentrated solutions, 
they precipitate proteins. The precipitated albumins form a pro- 
tective layer over the wound or the mucous surfaces, while the 
deeper structures are contracted, thus causing a shrinkage of the 
entire tissue mass, which gives to the smooth, succulent surface 
a dry, dense character. This favorable influence of astringents 
is especially noticeable on inflamed soft tissues that have become 
morbidly relaxed. The wound or inflamed mucous surfaces are 
tanned, a chemic process which is analogous to tanning hide into 
leather. Formaldehyd produces a similar action; the resultant 
chemic change differs from the true tanning, however, in so far 
as in genuine leather the tannic acid may be recovered, while 
from the formaldehyd-albumin combination the former can not 
be removed. 



172 PHARMACO-THERAPEUTICS. 

The astringent action of drugs manifests itself in a combina- 
tion of three definite ways: 

1. By contracting the muscular coat of the arterioles. 

2. By diminishing the secretion and transudation. 

3. By checking the migration of leucocytes — the formation of 
pus. 

The simple constriction of vessels is by no means identical with 
astringent action; for example, cocain and, more so, adrenalin 
are very powerful vaso-constrictors without producing the true 
astringent effect . The diminished secretion and transudation, 
and the checking of the migration of the leucocytes, result from 
the tanning of the intercellular cement substance between the 
endothelial cells, producing dense fibers of precipitated albumin, 
which block the passage of fluids or semi-solid materials. On 
unbroken skin, astringents act very slowly and in a much milder 
degree. 

If an astringent is dissolved in a surplus of blood, serum, or 
other tissue fluid, its typical action is destroyed. Absorbed astrin- 
gents produce no effect through the circulation, and consequently 
their internal administration for the purpose of acting through 
the blood is irrational. 

Astringent action is primarily manifested by the salts of the 
heavy metals, by tannic acid and its many modifications, and by 
some very diluted organic and inorganic acids. Those metallic 
salts which are readily soluble in water, and which are weak pro- 
toplasm poisons, are frequently employed as astringents. A few 
insoluble or less readily soluble metallic salts, like the salts of 
bismuth and zinc oxid, are also employed as astringents, and 
are frequently used as drying agents. The vegetable astringents 
are represented by tannic acid and its innumerable ill-defined 
modifications; they also precipitate proteins, gelatin, alkaloids, 
and many glucosids. The acids are at present rarely employed as 
astringents, with the possible exception of diluted acetic acid 
(vinegar), citric acid (lemon juice), and weak solutions of boric 
acid. Diluted alcohol and glycerin are sometimes employed for 
astringent purposes, which act by virtue of their great affinity 
for water. In the following table Schuetz has recorded the 



ASTRINGENTS. 



173 



diminution of the secretion as produced by the weakest concen- 
tration of the employed astringent: 



Tannic acid 0.05 percent 

Alum 0.06 percent 

Corrosive sublimate 0. 1 percent 

Hydrochloric acid 0. 12 percent 

Lead acetate 0.22 percent 

Silver nitrate 0.25 percent 



Sulphuric acid 0.5 percent 

Iron chlorid 0.5 percent 

Copper sulphate 0.6 percent 

Zinc sulphate 0.6 percent 

Acetic acid 0.8 percent 

Tartaric acid 4.0 percent 



Astringents are closely related to caustics, styptics, antiseptics, 
and protectives; the difference in their action is largely a matter 
of degree as regards the concentration of their solutions. 

Astringents are employed to protect wounded or inflamed 
mucous surfaces, to check hypersecretion, to contract superficially 
located blood vessels, and to reduce swollen mucous surfaces. All 
astringents coagulate blood very rapidly when they are brought 
in intimate contact with it, and consequently they are used as 
styptics. They „are frequently employed for the purpose of 
diminishing small, soft tumors of the mucous linings. Inter- 
nally they are employed for the treatment of diarrhea and dysen- 
tery. 

Metallic Astringents. 

Copper Sulphate; Cupri Sulphas, U. S. P., B. P.; 

CuS0 4 +5H,0. 

Etymology. — After Pliny, "xs cuprhim, an ore primarily 
found in Cyprus." 

Synonyms. — Cupric sulphate, blue vitriol, blue stone; sulfate 
de cuivre, F. ; Kupfersulfat, blauer Galitzenstern, G. 

Source and Character. — Copper sulphate is obtained by the 
interaction of water, sulphuric acid, and copper or copper oxid. 
It has a rich, blue color, a strong metallic taste, and appears in 
large crystals, which slowly effloresce in dry air. It is odorless, 
soluble in about 2.5 parts of water, 3.5 parts of glycerin, very 
soluble in boiling water, and almost insoluble in alcohol. It is 
incompatible with alkalies and their carbonates, lime water, iodide 
mineral salts (except sulphates), and most vegetable astringents. 
It attacks steel instruments. 



174 PHARMACO-THERAPEUTICS. 

Average Dose. — As an astringent, 1 / 5 grain (0.01 Gm.) ; as an 
emetic, 4 grains (0.25 Gm.). 

Medical Properties. — Astringent, stimulant, antiseptic, caus- 
tic, and emetic. 

Therapeutics. — Copper sulphate, like all other metallic salts, 
precipitates albumin, producing a superficial film of copper albu- 
minate. On exposed mucous membranes it acts as a caustic and 
strong astringent. It is milder in its action than silver nitrate or 
zinc chlorid. Administered internally, by its irritating effect 
on the mucous membrane of the stomach, it acts as a rapid direct 
emetic, and is well suited for that purpose when the stomach is to 
be surely and promptly emptied of a poison, like opium, etc. It 
is an active antidote in acute phosphorus poison ; it does not 
act merely as an emetic, but it partially oxidizes the phosphorus 
and partly covers it with metallic copper as a result of the reduc- 
tion produced by the pieces of phosphorus. When it is adminis- 
tered for a longer period, it may cause greenish discoloration of 
the teeth, but not of the gums. 

Copper sulphate is used in y 2 to 2-percent solutions as a stimu- 
lating astringent for indolent ulcers, the antrum, etc. It is 
highly recommended, and by some considered a specific, for the 
treatment of pyorrhea alveolaris. After the thorough removal of 
calcareous deposits from the roots of the teeth, the pockets are 
cleansed with an antiseptic solution, and the finely powdered cop- 
per sulphate,, mixed with water into a thick paste, is pushed into 
the pockets by means of a toothpick or a looped .platinum wire. 
Cook 1 recommends for such purposes a saturated solution of the 
salt in lactic acid. Applied on carious dentin as a sterilizing 
agent, it is very likely to stain the tooth a permanent greenish- 
blue. Copper sulphate enjoys a wide and well-deserved reputation 
as a means of destroying lower forms of life in polluted water. 
The much heard of cry of "poisoning with copper" is wholly un- 
founded, as the quantity necessary to purify water (1*500,000) 
is too small to cause any serious effects on the health of the con- 
sumer. 

Cuprol. It is a nuclein of copper, containing about 6 percent 



1 Cook: American Dental Journal, 1905, p. 205. 



ASTRINGENTS. 175 

of the latter. It is a green powder, readily soluble in water. Its 
solution does not coagulate albumin. 

Alum and burnt alum are useful astringents on wound sur- 
faces, etc. Solution of aluminum acetate, containing about 8 per- 
cent of aluminum acetate, is much lauded as a mouth wash (a 
tablespoon ful in a glassful of water) in all conditions where a 
mild, yet positive, astringent is indicated. 

Lead Acetate; Plumbi Acetas, U. S. P., B. P.; Pb(C,H 3 2 ) 2 
+3H 2 ; Sugar of Lead; Sucre de Saturne, F. ; Blei- 
zucker, G. 

It forms colorless shining crystals, having a sweetish, astrin- 
gent, afterward metallic taste. It is soluble in 2 parts of water 
and 30 parts of alcohol. Exposed to the air, it effloresces and 
absorbs carbon dioxid. It is incompatible with acids, sulphates, 
chlorids, tannin, phenol, and vegetable infusions and tinctures. 
Lead acetate is poisonous. 

Average Dose. — 1 grain (0.06 Gm.). 

Solution of Lead Subacetate ; Liquor Plumbi Subacetatis, U. S. 
P.; Liquor Plumbi Subacetatis Fortis, B. P.; Goulard's Extract. 
It is an aqueous solution, containing about 25 percent of lead 
subacetate. It is usually employed in the form of lead water. 

Diluted Solution of Lead Subacetate; Liquor Plumbi Subaceta- 
tis Dilutus, U. S. P., B. P. ; Lead Water; Goulard's Lotion. It 
contains about 7.5 parts (3 parts, B. P.) of the subacetate in 1,000 
parts of water. Lead water is. frequently employed as an external 
cooling sedative astringent in local inflammation, sprains, bruises, 
etc. ; it is applied pure, or in combination with laudanum in the 
proportions of 1 ounce of tincture of opium to 1 / 2 pint of lead 
water. 

Zinc Chlorid; Zinci Chloridum, U. S. P., B. P.; ZnCL. 

Etymology. — Zinc is first spoken of in the writings of Basilius 
Valentinus and Paracelsus in the fifteenth century, without men- 
tioning where it was obtained. The later medical chemists 
usually spoke of zinc ores in general as "zinc. 7 ' 

Synonyms. — Butter of zinc ; chlorure de zinc, F. ; Chlorzink, G. 

Source and Character. — It is the product of the interaction 



176 PHARMACO-THERAPEUTICS. 

between hydrochloric acid and zinc. It occurs as a white, granular 
powder or porcelain-like masses, or molded into pencils; odor- 
less, and of such intensely caustic properties as to make tasting 
dangerous unless the salt be dissolved in much water. It has a 
strong metallic, astringent taste, is very deliquescent, and should 
be kept in glass-stoppered bottles. It is soluble in 0.4 parts of 
water and very soluble in alcohol, glycerin, and ether, and its 
solutions have an acid reaction. It fuses at 240° F. (115° C.) 
to a clear liquid. It is incompatible with alkalies and their car- 
bonates, with lead acetate, silver nitrate, the tannates, and lime 
water. 

Average Dose. — */ 2 grain (0.03 Gm.), largely diluted. 

Preparations. — 

Liquor Zinci Chloridi, U. S. P., B. P. Solution of zinc chlorid 
(Burnett's disinfecting fluid). It contains about 50 percent of 
the salt. 

Medical Properties. — Caustic, disinfectant, and astringent. 

Therapeutics. — In its local action, zinc chlorid resembles 
closely the salts of lead, silver, and copper, forming albuminates 
by its chemic union with the tissue fluids. The precipitated 
albumin is of a loose, flocculent nature. Applied in substance, it 
quickly liquefies and penetrates into the soft tissues, destroying 
the parts, which is usually accompanied by severe pain. It acts 
as a powerful and penetrating caustic. As a stimulating astrin- 
gent, it is employed in aqueous solutions, either alone or in com- 
bination with antiseptics, and as a component of mouth washes 
which are to be continuously used it should be limited to 1 :3,000 
of the solution. In the form of a paste, known as Canquoin's 
paste, consisting of equal parts of wheat flour and zinc chlorid r 
with very little water, it is directly applied to carcinomatous 
growths, lupus, etc. It is seldom given internally. 

Zinc chlorid enjoys quite a reputation as a very efficient topical 
remedy for the treatment of hypersensitive dentin. It is applied 
to the isolated and partially dried tooth in substance or in a con- 
centrated solution. At first usually severe pain is experienced, 
which soon ceases, leaving a superficially anesthetized surface. 
It does not penetrate the dentin very deeply unless applied in ex- 



ASTRINGENTS. 177 

cess or for a long period. Too close proximity to the pulp forbids 
its use for the above purpose, as it endangers the life of this organ. 
Technically, it is used in various dental cements and as a solder- 
ing flux in the laboratory. 

Toxicology. — Internally, zinc chlorid acts as a corrosive poison, 
somewhat similar to mercuric chlorid. The treatment consists 
in emesis. which is usually produced by the salt itself, and in 
demulcent drinks — white of egg. or milk — and stimulants. 

Zixc Sulphate: Zixci Sulphus, U. S. P.. B. P.; ZnS0 4 +7H 2 0. 

Synonyms, — White vitriol : vitriol blanc. F. : Weissei Vitriol, 
Weisser Galitzenstein. G. 

Source and Character. — It is formed by the interaction of 
zinc and diluted sulphuric acid. It appears in colorless, trans- 
parent crystals, without odor, and has an astringent, metallic 
taste. It is soluble in 0.6 parts of water, 3 parts of glycerin, and 
is insoluble in alcohol. 

Average Dose. — As an emetic, 15 grains (1 6m.), dissolved 
and well diluted with water. 
Medical Prorerties. — Tonic, astringent, antiseptic, and emetic. 

Therapeutics. — Zinc sulphate is principally used as an astrin- 
gent in 1 ' 2 to 10-percent solutions in ulcerated conditions of the 
mouth. It is much weaker in its action than zinc chlorid. By 
its irritating effect on the mucous membrane of the stomach it 
acts in larger doses as a direct and prompt emetic. 

Astrixgext Solution for the Oral Cavity. 

fy Zinc, sulphat. 5 j (4.0 Gm.) 

Glycerin. A3 ij (8 Cc.) 

Aquae rosse ad fl§ ij (60 Cc.) 

M. 

Sig. : To be diluted with an equal amount of water and 
used as a mouth wash. 

Zinc Phexolsulphoxate ; Zixci Phexolsulphoxas, U. S. P. ; 
Zixci Sulphocarbolas, B. P.; Zn(C 6 H 5 4 S) 2 ; Zixc Sulpho- 

CARBOLATE. 

It appears in colorless, transparent crystals, and is soluble in 
about twice its weight of alcohol or water. It is an antiseptic, 



178 PHARMACO-THERAPEUTICS. 

stimulant, and astringent. Its solutions are employed for similar 
purposes as those of zinc sulphate and in about the same strength. 
Whitslar 1 has recently advocated a 10-percent aqueous solution of 
this salt as an efficient astringent and antiseptic for the treatment 
of pyorrhea; he injects it deeply into the pockets. Whether zinc 
phenolsulphonate possesses greater advantages than the other 
metallic astringents and antiseptics in the treatment of pyorrhea 
alveolaris is questionable. 



L 2" 



Zinc Iodid; Zinci Iodidum, U. S. P.; ZnL 

It is a white granular powder, odorless, and has a sharp saline 
and metallic taste. It is readily soluble in water, alcohol, ether, 
and glycerin. The salt is liable to spontaneous decomposition, 
and, as it is also very deliquescent, it should be kept in glass- 
stoppered bottles. It is strongly astringent, and on account of 
its iodin component promotes tissues changes. Talbot praises 
the value of zinc iodid in the form of a glycerin ated solution for 
the treatment of inflammatory conditions of the gums accom- 
panying pyorrheal disturbances. Talbot's solution of this salt 
deserves to be highly recommended. As all iodin preparations 
ruin ordinary metallic instruments, they are best applied on an 
iridio-platinum applicator or on a toothpick wound w T ith cotton. 

Talbot's Glycerol of Zinc Iodid. 

Zinc iodid 15 parts. 

Distilled water 10 parts. 

Iodin 25 parts. 

Glycerin 50 parts. 

Bismuth Subgallate ; Bismuthi Subgallis, U. S. P. ; Derma- 
tol. 

An amorphous saffron-yellow powder, without odor and taste, 
yielding about 50 percent of bismuth oxid. It is insoluble in 
water, alcohol, and ether, but soluble in diluted alkalies and acids. 
It is used as an intestinal astringent and antiseptic, and exter- 
nally as a dusting powder on wound surfaces, etc. Average dose, 
4 grains (0.25 Gm.). 

1 Whitslar: Dental Summary, 1907, No. 8. 



ASTRINGENTS. 179 

Bismuth Subnitrate; Bismuthi Subnitratis, U. S. P., B. P.; 
Magisterium Bismuthi; Bismuth Oxynitrate. 

A white heavy powder, without odor and taste, and yielding 
about 80 percent of pure bismuth oxid. It is insoluble in water 
and alcohol, but soluble in acids. It is used as an internal anti- 
septic and astringent, and externally as a dusting powder on wound 
surfaces, etc. The insoluble bismuth salts act as absorbents on 
wound secretions, thus rendering the surface less suitable for the 
growth of bacteria. Bismuth is not a harmless remedy when 
applied for a prolonged period, and several cases of poisoning have 
been recorded from its surgical use. Average dose, 7 1 /, grains 
(0.5 Gm.). 

Xeroform; Bismuth Tribromphenolate. A neutral, yellow, in- 
soluble powder, without odor and taste, yielding about 60 percent 
of bismuth oxid. It is used as an astringent and antiseptic in the 
form of a dusting powder, and is recommended as a substitute 
for iodoform. 

Alumnol ; Aluminum Naphtoldisulphonate. 

A white powder, readily soluble in water and glycerin, and 
slowly soluble in alcohol. Its solution exhibits a bluish fluores- 
cence; on exposure to air the powder darkens. It is used as an 
external antiseptic and astringent in 1 / 2 to 2-percent solutions. 
In strong solutions (10 to 20 percent) it is caustic. 

Zinc Oxid; Zinci Oxidum, U. S, P., B. P.; ZnO. 

Synonyms. — Nihil album, lana philosophica, flowers of zinc; 
oxyde de zinc, F. ; Zinkoxyd, Zinkblumen, G. 

Source and Character. — Zinc oxid is made by exposing zinc 
carbonate to a dull red heat, or from metallic zinc by combus- 
tion. It is an amorphous white powder, without odor and taste. 
It is insoluble in water and alcohol ; it gradually absorbs carbon 
dioxid from the air. 

Average Dose. — 4 grains (0.25 Gm.). 

Medical Properties. — Antispasmodic and astringent. 

Therapeutics. — Zinc oxid is employed as an exsiccant on ex- 



180 PHARMACO-THERAPEUTICS. 

coriated surfaces by sprinkling it on the affected part, or in the 
form of an ointment (zinc oxid, 1 part; benzoinarted lard, 4 parts, 
U. S. P.). It is much used as a cosmetic in the form of face 
powder. Internally it is given in chorea, epilepsy, etc. * 

Technical Uses. — Zinc oxid forms the base of the various 
zinc cements employed in dentistry. At present the oxychlorid, 
the oxyphosphate, and the oxysulphate cements are utilized. In 
1856 Sorel, of Paris, introduced a method for preparing stucco 
work, "consisting of a coating of zinc oxid overlaid with a coating 
of zinc chlorid." The inventor suggested its employment "to 
stop hollow teeth, for which its plasticity and subsequent impene- 
trability to the moisture of the mouth rendered it particularly 
applicable." Sorel's cement consists of a powder (calcined zinc 
oxid) and a liquid, which is a concentrated aqueous solution of 
zinc chlorid. The addition of small quantities of borax lessens 
the rapid setting of the cement. The oxychlorid cement is not 
used at present as a permanent filling material, but it is still 
lauded by many practitioners as the ideal root filling, either alone 
or in combination with gutta-percha cones. If the cement is 
placed in too close proximity to the pulp, it may produce persist- 
ent irritation, or even death of this organ. 

The Rostaings, father and son, dentists in Dresden, prepared 
in 1878 a filling material known as Dentinagen, consisting essen- 
tially of a mixture of phosphoric acid with zinc oxid. The combi- 
nation is known at present as oxyphosphate of zinc cement. The 
various zinc oxyphosphate cements play an important role in the 
armamentarium of the dental practitioner. These cements consist 
principally of a powder (calcined zinc oxid) and a syrupy solu- 
tion of orthophosphoric acid. 

A zinc oxysulphate cement, better known as Fletcher's artifi- 
cial dentin, has proved itself to be a valuable agent for temporary 
filling purposes. It is essentially a mixture of calcined zinc oxid, 
calcined zinc sulphate, gum mastic, and a fluid consisting of a 
thin gum arabic solution. The mixture attains about the hard- 
ness of hydrated plaster of Paris. This cement is largely used for 
the retention of medicinal application in teeth, and, combined 
with formaldehyd, is sold under various euphonious titles. 



ASTRINGENTS. 181 

OxYSULPHATE OF ZlNC CEMENT (ARTIFICIAL DENTIN). 

POWDER. 

Powdered mastic. 7^ parts. 

Calcined zinc oxid 100 parts. 

Calcined zinc sulphate 12 parts. 

LIQUID. 

Gum arabic 25 parts. 

Water 65 parts. 

Alcohol 10 parts. 

Liquid phenol % part. 

Zinc Acetate; Zinci Acetas, U. S. P., B. P.; 

Zn(C 2 H 3 2 ) 2 +2H 2 0. 

Tt is a white crystalline powder or plates, soluble in 2 1 /, parts 
of water and 36 parts of alcohol. It is astringent and antiseptic, 
and is employed in V 2 -percent solutions. 

Zinc Sozo-Iodolate; Zinc Sozo-Iodolas. Tt appears in colorless 
needles, which are soluble in 25 parts of water, in alcohol, and 
in glycerin. It is antiseptic and astringent, and is employed in 
1 / 2 to 2-percent solutions. 

Zineol. It is a mixture of 1 part of zinc acetate and 4 parts of 
alumnol (aluminum beta-naphtoldisulfonate) : it is a colorless and 
odorless powder, which dissolves freely in water. It is a non- 
irritating antiseptic and astringent, and is employed in V 2 -percent 
solution. 

Vegetable Astringents. 

Tannic Acid; Acidum Tannicum, U. S. P., B. P.; HC 14 H 9 9 . 

Synonyms. — Tannin, gallo-tannic or digallic acid: acide tan- 
nique, Fr. ; Gerbsaure, G. 

Source and Character. — Tannic acid is an organic acid ob- 
tained from nutgall. It is a light-yellow, amorphous bulky pow- 
der or spongy mass, with a slight odor and a strongly astringent 
taste. It is soluble in 1 part water or glycerin, 0.6 parts alcohol, 
very soluble in hot water and hot alcohol. With albumin and 
glue-like substances of the tissues it forms definite compounds 
(leather), which are insoluble in water, but partially soluble in 



182 PHARMACO-THERAPEUTICS. 

alkalies and certain acids. Its astringent action is manifested 
even in very weak solutions (y 20 percent). It is incompatible 
with the metallic salts, with the iodin compounds, and with easily 
oxidizable substances — as the permanganates, chlorates, etc. ; with 
ferric salts it forms blue-black or green -black reaction. It should 
be preserved in amber-colored bottles, well stoppered. 

Average Dose. — 7 1 / 2 grains (0.5 Gm.). 

Medical Properties. — Astringent, styptic, and antiseptic. 

Therapeutics. — Tannic acid acts as a powerful astringent, 
exercising its function on vessels and tissue fibers; it coagulates 
blood. When placed on the oral mucous membrane, a coagula- 
tion of the superficial layers results, which causes a feeling of 
constriction, dryness, and roughness in the mouth. By its com- 
bination with the secretions of the wound it forms a protective 
film over the denuded surfaces. If applied in concentrated solu- 
tion, it irritates and may act even as a caustic. Tannic acid is 
used as an astringent gargle in catarrhal conditions of the pha- 
rynx (1 to 2-percent solutions), and internally in disturbances 
of the stomach and the intestines. As an internal astringent in 
diarrhea and dysentery it is of doubtful value. It is much used 
as an external astringent and styptic in powder form or in con- 
centrated solution, preferably as the glycerite of tannic acid. It 
is a valuable agent for the treatment of hyperemia and the early 
stages of inflammation of the pulp, and for such purposes it is 
usually applied in a paste form — tannic acid mixed with phenol 
or eugenol. As a tanning agent of the devitalized pulp, it is best 
applied in the form of a glycerite. The pure acid or its many 
modifications — rhatany, witch-hazel, oak bark, etc. — are largely 
used as components of mouth washes. (See Preparations for the 
Mouth and Teeth.) 

Tannic acid is frequently employed as an antidote for alkaloids 
when these poisons are taken into the stomach. It readily precipi- 
tates the alkaloids, forming tannates, which should be removed 
from the stomach with emetics or the stomach pump. Tea or 
coffee are usually available for such purposes; they contain more 
or less sufficient tanning to render them important adjuncts in 
emergency treatment. 



ASTRINGENTS. 183 

Styptic Dusting Powder. 

$. Alum. ust. 

Acid, tannic. aa 3 J (4.0 Gm.) 

M. 
Sig. : Styptic dusting powder. 

Gallic Acid; Acidum Gallicum, U. S. P., B. P. An organic 
acid, usually prepared from tannic acid. It has no astringent 
effect, and possesses very little medicinal value. 

Quite recently a large number of synthetically prepared tannic 
acid compounds have been introduced into therapeutics, espe- 
cially for internal administration. The principal object of these 
preparations has been to overcome the disagreeable taste and irri- 
tating action of tannic acid, and to reach the upper intestines 
without becoming decomposed by the gastric juice. The more 
important ones are: « 

Tannalbin. A tannin albuminate. It is a light-brown, odor- 
less, and tasteless powder, containing about 50 percent tannin. It 
is insoluble in water and in the gastric juice. It is used as an 
intestinal astringent. Average dose, 10 grains (0.6 Gm.). 

Tannoform. A condensation product of formaldehyd and 
tannin. It is a reddish powder, insoluble in water, but soluble in 
alkaline liquids. It is applied externally as an antiseptic astrin- 
gent. 

Many other combinations of tannin with organic bodies are 
known — as tanocol, a tannin-gelatin compound; tannopin, a 
hexamethylenamin-tannin ; tqnningen, a diacetyl-tannin com- 
pound, etc. 

Witch-Hazel Water; Aqua Hamamelidis, U. S. P. ; Extractum 
Hamamelidis Liquidum, B. P.; Liquid Witch-Hazel Extract. 
Both are solutions of the active principle of witch-hazel bark 
(especially gallic and hamamelo-tannic acid) in very diluted 
alcohol. They are favorite and pleasant astringent lotions applied 
by the laity as antiphlogistic and styptic remedies after the extrac- 
tion of teeth, for spongy gums, etc. 

Rhatany; Krameria, U. S. P., B. P. The dried roots of a 
variety of rhatany plants. Rhatany contains on an average from 
7 to 8 percent of kramero-tannic acid and some red coloring mat- 



184 PHARMACO-THERAPEUTICS. 

ter. It is especially to be recommended as an oral astringent in 
the form of a diluted tincture (rhatany, 1 part; diluted alcohol, 
5 parts). 

White Oak Bark; Quercus, U. S. P. The dried bark of white 
oak. It contains about 7 percent of querci-tannic acid. It is 
usually employed as an astringent and styptic in the form of an 
infusion or of the diluted fluidextract. As an astringent for the 
oral cavity it is much favored by some practitioners. 

Other plants — as sumach, blackberry, cranesbill, logwood, kino, 
catechu, etc.— contain variable amounts of ill-defined tannic acid 
modifications, but are rarely used in dental practice. 

CAUSTICS. 

Caustics (I burn), sometimes called escharotics (a slough or 
burn), are substances which destroy living tissue by virtue of 
their coarse chemic or physical action, affecting organized as 
well as nonorganized albumin. The older medical lexicog- 
raphers restricted the term escharotic to substances which pro- 
duce a dry, more or less insoluble, protective slough. The true 
caustic action manifests itself essentially in two definite processes : 

1. It produces coarse chemic or physical changes in the tissue. 
These changes are macroscopically recognizable. 

2. It causes the more or less indirect death of these affected 
tissues. 

Pure chemic drug action on cell structure which endangers, 
or even kills, the cell without visible changes is referred to as 
protoplasm poisoning, while a drug which produces severe visible 
tissue changes, but without cell destruction, is spoken of as an 
irritant. , 

Caustic action means destruction of protoplasm. It may be 
produced : 

1. By abstracting water from albumin. The normal quantity 
of water present in the living cell amounts to 75 to 90 percent. If 
a more or less greater amount of this water is removed, the cell 
will die. The neutral salts, glycerin, etc., are chemicals which 
produce such an effect. (If sodium chlorid is taken in large 



CAUSTICS. 185 

quantities into the empty stomach, it may produce severe cauteri- 
zation of the stomach wall, or even death.) Substances which 
act only by virtue of their affinity for water are not employed 
as caustics in medical practice. 

2. By dissolution of albumin. Alkalies and caustic alkalies 
are albumin solvents. The saturated alkaline salts — potassium 
or sodium carbonate — are mild caustics, while potassium or 
sodium hydrate, which contain free hydroxyl groups, are very 
powerful in their action. The caustic alkalies are not self -limit- 
ing; they penetrate deeply into the tissues, and destroy the 
albumin of the mucous surfaces, the horny tissues, and the 
external skin. The lower fatty acids act also as solvents of 
albumin. 

3. By precipitation of albumin. Agents acting as albumin pre- 
cipitants are: (a) Many acids — all inorganic acids, except 
phosphoric acid; the chlorin substituted fatty (organic) acids, 
and those aromatic acids which are readily soluble in water to 
such an extent as to produce the desired effect — tannic acid; the 
resultant acid-albumin is known as syntonin. (b) Solutions of 
metallic oxids and their salts; they act as precipitants of albumin 
through their acid as well as through their basic components; 
the precipitate produced by the metallic salts differs widely in 
regard to its density — silver nitrate, for instance, produces a 
dry. dense scab, while zinc chlorid combines with the albumin to 
form a loose, nocculent clot, (c) Certain organic compounds — 
as phenol, trinitrophenol (picric acid), and alcohol; the latter 
precipitates albumin only when applied in solutions containing 
at least 65 percent or more of pure alcohol. 

4. By oxidation. The strong oxidizing agents, like nitrous 
acid, sulphurous acid, and chromic acid (chromium trioxid) , dis- 
integrate albumin, as well as many other organic and inorganic 
substances ; they completely destroy the albumin molecule. 

5. By substitution. Iodin, bromin, and chlorin, act on the 
albumin molecule by substitution — that is, atoms of hydrogen 
are replaced by atoms of the whole halogen, which destroy the 
life of the cell; at the same time halogen acids are formed, 
which act as precipitants of albumin. 



186 PHARMACO-THERAPEUTICS. 

In general, caustics are more or less related to antiseptics, 
astringents, styptics, and irritants. The tissues involved by their 
application are always superficially destroyed. Certain caustics 
(potassium hydrate) act on the deeper structures. The vessels 
within the area of the applied caustic become thrombosed, and 
the blood corpuscles disintegrate. A reactive inflammation is set 
up within the region of the applied caustic, which in due time 
removes the scab formed by the latter. 

Caustics are employed for the purpose of destroying living or 
dead tissue. Besides chemicals, the knife, the actual cautery, 
either in the form of the electric cautery or the old-fashioned 
ferrum candens, or electrolytic destruction is used. 

Caustics are indicated: 

1. To destroy specific poisons. For the treatment of fresh in- 
fections on external surfaces resultant from the bite of a poisonous 
snake or a scorpion, or all such accidents which inoculate the 
wound with a nonbacterial or specific poison, potassium perman- 
ganate in concentrated solution is highly recommended. 

2. To destroy bacterial infection. Local infection resultant 
from the bite of a vicious dog (hydrophobia), or from an anthrax 
carbuncle, or a chancre, etc., is destroyed by the application of 
lactic acid, or, in severe cases, of chromic acid, or caustic potash; 
the latter has a pronounced deep action. 

3. To destroy tumors, neoplasms, and normal or abnormal 
tissue. Polypi, epulis, small aneurysms, hypertrophied mucous 
membrane or gum tissue, and intense granulation in a wound 
(proud flesh) are destroyed or checked by the application of solu- 
tions of trichloracetic acid in various strengths. To destroy the 
tooth pulp, arsenous acid (arsenic trioxid) is the remedy par 
excellence. 

4. To inhibit the progress of dental caries. Silver nitrate, con- 
tinuously applied in substance or in concentrated solution until 
the silver has been reduced to a jet black oxid by the. action of 
sunlight, will absolutely inhibit the progress of dental caries. 

5. To keep fistulas open, or to destroy their epithelial lining. 
Liquid phenol, followed by alcohol, deserves to be recommended 
for such purposes. 



CAUSTICS, 187 

The application of caustics is usually accompanied by severe 
pain, which, to some extent, may be mitigated by the previous 
application of local anesthetics. The destruction of a large area 
of tissue is usually followed by the formation of a more or less 
extensive cicatrix, and extreme care should therefore be exercised 
in the use of caustics. 



Liquid Caustics. 

Trichloracetic Acid; Acidum Trichloraceticum, U. S. P.; 

HC 2 C1 3 2 . 
It forms white deliquescent crystals, having a pungent, char- 
acteristic odor. It is readily soluble in water, alcohol, and ether. 
A 50-percent aqueous solution is known as acetocaustin. It is a 
powerful caustic and astringent. »In 50-percent solution it is 
used to destroy polypi, epulitic growths, gum tissue, etc. In 5 to 
10-percent solution, either alone or in combination with other 
drugs, it is employed for the treatment of alveolar pyorrhea. It 
should be applied with a glass rod or on a looped platinum wire. 

Lactic Acid; Acidum Lacticum, U. S. P., B. P.; C 3 H 6 3 . 

A colorless liquid organic acid, containing 75 percent of pure 
lactic acid. It is freely miscible with water, alcohol, and ether, 
but insoluble in chloroform. It has a distinct sour taste. In 
its pure form it is used as a caustic swab on the patches of leuco- 
plakia and in pyorrhea pockets. 

Solution of Sodium Ethylate ; Liquor Sodii Ethylatis, B. P. 

An 18-percent solution of sodium ethylate in absolute alcohol. 
A colorless, syrupy liquid, which decomposes in the presence of 
water ; it should be recently prepared. It is a mild caustic, which 
does not penetrate deeply into the tissues. 

Nitric Acid; Acidum Nitricum, U. S. P., B. P.; HN0 3 . 

A colorless fuming fluid, containing about 68 percent of abso- 
lute nitric acid, and has a suffocating odor. It is very caustic 



188 PHARMACO-THERAPEUTICS. 

and corrosive, staining woolen fabrics and animal tissues a bright 
yellow. It should be handled with great care. 

Liquid phenol, sometimes creosote, and, to a still less extent, 
cresol, are quite frequently used as caustics. As these agents 
are very readily soluble in alcohol, their action on the tissues is 
limited by following their application with a swab of pure alcohol. 



Dry Caustics. 

Potassium Hydroxid; Potash Hydroxidum, U. S. P.; Potassa 
Caustica, B. P.; KOII: Caustic Potash. 

Dry white, fused masses, or in pencils, having a faint odor of 
lye and a very acrid caustic taste. It readily absorbs moisture 
and deliquesces. It is soluble in 0.4 parts of water and in 2 
parts of alcohol. 

Solution of Potassium Hydroxid; Liquor Potassii Hydroxidi, 
U. S. P. ; Liquor Potassse, B. P. An aqueous solution of potas- 
sium hydroxid, containing about 5 percent of the salt. 

Sodium Hydroxid; Sodii Hydroxidum, U. S. P.; NaOH; 

Caustic Soda. 

White, transparent pencils, which are deliquescent in the air 
and very caustic. 

Solution of Sodium Hydroxid; Liquor Sodii Hydroxidi, U. S. P. 

An aqueous solution of sodium hydroxid, containing about 5 

percent of the salt. 

Robinson's Remedy. 

J$l Phenolis crystal. 

Potassii hydroxidi aa 3 J (4.0 Gm.) 

M. 

Sig. : Mix by triturating in a mortar until a crystalline 
paste is formed. Apply on a loosely rolled twist of cotton 
about the neck of a tooth for alveolar pyorrhea. 

Schreier's Alloy of Potassium and Sodium {Kalium-N atrium) . 
An alloy of metallic potassium and sodium kept in a bottle 
tightly sealed with a thick layer of paraffin. To remove the prep- 
aration, a barbed nerve broach is pushed through the paraffin 
stopper. Handle with care. 



CAUSTICS. 189 

Osmium Tetroxtd; Acidum Osmium; Os0 4 ; Osmtc Acid. 

Yellowish crystals, having a very pungent odor ; readily soluble 
in water, alcohol, and ether. It is a very powerful caustic, and 
its vapors are exceedingly irritating to the air passages and the 
eyes. Osmic acid has a special affinity for fatty and nerve sub- 
stance, and is therefore recommended in the form of an injection 
in V20 to V 6 -grain (0.003 to 0.01 Gm.) doses several times a day 
as a 1-percent solution (consisting of 60 parts of water and 40 parts 
glycerin) in trigeminal neuralgia as a means of destroying the 
sensory nerve tissue. As osmic acid, by reduction, produces a 
black stain, it may permanently discolor the face. 

Chromium Trioxid; Chromii Trioxidum, U. S. P.; Acidum 
Chromicum, B. P. ; Cr0 3 ; Chromic Acid; Chromic Anhydrid. 
It forms small crystals of a purplish-red color and a metallic 

luster ; is odorless, and destructive to animal and vegetable tissues. 

It is deliquescent in moist air, and very soluble in water. When 

brought in contact with organic substances — as cork, tannic acid, 

sugar, alcohol, collodion, glycerin, etc. — decomposition takes place, 

and sometimes with dangerous violence. 

Solution of Chromic Acid; Liquor Acidi Chromii, B. P. An 

aqueous solution of chromium trioxid in water, containing about 

29 percent of the anhydrid. 

Barium Sulphid; Barii Sulphidum; BaS. 

A yellowish-green, amorphous and phosphorescent powder or 

lumps, having a pronounced odor of hydrogen sulphid. It is 

employed as a convenient and comparatively harmless means of 

removing hair from body surfaces in the form of a depilatory 

paste. 

Depilatory Paste. 

Ifc Barii sulphidi 5 ij (8.0 Gm.) 

Zinci oxidi 

Amyli aa 3 iij (12.0 Gm.) 

M. 

Sig. : Mix with water to a creamy paste, and apply thickly 
with a wooden spatula over the hairy surface. In a few 
minutes it should be washed off and a bland ointment applied. 
The paste should be freshly prepared. 



190 PHARMACO-THERAPEUTICS. 

Silver Nitrate; Argenti Nitras, U. S. P., B. P.; AgN0 3 . 

Etymology. — The word silver is derived from the old English 
selver or the Anglo-Saxon seolfor. The Latin argentum and the 
Greek ar gyros are derived from the same root, argos, meaning 
white, while the Hebrew term keseph is derived from a root 
meaning pale. The alchemists termed silver luna or diana. 
Geber, the celebrated Arabian alchemist of the eighth century, is 
the first writer who refers to a formula for making crystalline sil- 
ver nitrate, and Augustus Sala, at the end of the seventeenth cen- 
tury, called the attention of the medical chemists to this salt, 
which he named crystalli dianse or magisterium argenti, from 
which, by melting, he obtained the lapis infernalis. 

Synonyms. — Lunar caustic, lapis infernalis; pierre infernale, 
F. ; Hollenstein, G. 

Source and Character. — Silver nitrate is usually prepared by 
dissolving pure silver in diluted nitric acid and set aside for 
crystallization. "It is a colorless and transparent tubular, rhom- 
bic crystalline salt, becoming gray or grayish-black on exposure 
to light in the presence of organic matter; odorless, having a bit- 
ter, caustic, and strongly metallic taste and a neutral reaction; 
soluble at 77° F. (25° C.) in 0.54 parts of water and 24 parts of 
alcohol, and in 0.1 part of boiling water and 5 parts of boiling 
alcohol. When heated to about 392° F. (200° C.) the salt melts, 
forming a faintly yellow liquid, which, on cooling, congeals to a 
pure white crystalline mass. At a higher temperature it is grad- 
ually decomposed with the evolution of nitrous vapors. It should 
be kept in dark-colored vials, protected from light." 

The solution stains the skin an indelible black, and it is itself 
discolored by the most minute portions of organic matter, for 
which it forms a delicate test. The solution also stains linen and 
muslin fibers, and exposure to sunlight hastens this process. To 
remove the stains, a solution of sodium hyposulphite, potassium 
cyanid, or ammonium chlorid may be readily employed. It is 
incompatible with ordinary water on account of the sodium chlorid 
which it contains, with soluble chlorids in general, with the min- 
eral acids, with alkalies and their carbonates, with lime water, and 
with astringent infusions. 



CAUSTICS. 191 

Average Dose. — 1 / 5 grain (0.01 Gm.). 

Preparations. — 

Argenti Nitras Fusus; Molded Silver Nitrate or Lunar Caustic, 
U. S. P. It is prepared by melting 100 grams of silver nitrate with 
4 grams of hydrochloric acid and poured into suitable molds. The 
British Pharmacopeia prepares a toughened caustic, argenti nitras 
induratus, by adding 5 parts of potassium nitrate to 95 parts of 
silver nitrate. 

Argenti Nitras Mitigatus; Mitigated Caustic, U. S. P. It is 
prepared by melting 30 grams of silver nitrate with 60 grams of 
potassium nitrate and cast into suitable molds. 

Medical Properties. — Antiseptic, astringent, caustic, and 
hemostatic. 

Local and General Action. — When solid silver nitrate is 
brought in contact with living tissue, a deep staining of the super- 
ficial layer is produced as a result of the reduction of the silver, 
followed by acute pain and partial inflammation of the deeper 
structures, resulting in destruction of the upper layers, which 
finally separate as a slough; the corroded surfaces heal quickly. 
On the mucous membranes or the broken skin it acts much like 
lead salts, but more powerful, while it is less active than the 
mercury salts. It readily precipitates albumins and chlorids from 
the plasma or the serumnal discharge ; in weak solutions it actively 
contracts arteries and veins. The formation of a protective layer 
of coagulated albumin limits its penetration into the deeper struc- 
tures and reduces its action to an astringent. The precipitation 
of albumin is fairly recognizable in y 4 -percent solution — it in- 
creases with the density of the latter; a 10-percent solution pro- 
duces a firm coagulum. By its controlling influence on the vascu- 
lar disturbances, the exudations, and the growth of the inflamma- 
tory area, it acts as an antiphlogistic. In solid form it is employed 
as a hemostatic. Silver nitrate is the most powerful caustic and 
astringent of all the metallic salts which can be applied with 
safety. Locally it does not produce toxic effects or dangerous in- 
flammatory disturbances, as its action is distinctly self-limiting. 
Given internally for a longer period, or even from the prolonged 
use of silver solution by external application on mucous surfaces 



192 PHARMACO-THERAPEUTICS. 

or denuded skin, the silver is quite often retained in the system, 
and permanently stains the body surfaces by forming dense gran- 
ules in the connective tissue, thus giving the skin and mucous 
membrane an unsightly dark-brown appearance, known as argyria. 
The pigmentation was more common in earlier years than at 
present, owing to its restricted internal use. 

Specific Application in Dentistry. — As early as, 1846 we 
read in the "Zahnarzt" that the application of silver nitrate to 
carious surfaces on teeth is very beneficial, as it "practically stops 
the progress of the carious process." Brooks, 1 in 1854, calls at- 
tention to the value of this chemical in the treatment of erosion, 
saying that "it does discolor the cavity, but it prevents further 
progress." A number of prominent practitioners — as Clark, 
Chupein, Shanasy, Tomes, Salter, Bauer, Black, Miller, Pierce, 
Conrad, and many others — have greatly lauded the value of silver 
nitrate as a means of abating the progress of dental caries, and 
especially Taft, 2 as early as 1859, expresses himself most favor- 
ably on this subject: 

"The compound formed by the nitrate with the organic con- 
stituents of the tooth is insoluble, except with a few substances, 
and therefore protects the subjacent parts, and the precipitation of 
the reduced oxid on the surface affords some additional protection. 
The insolubility of the compound mentioned prevents an absorp- 
tion of the nitrate by the dentin, and renders its action necessarily 
superficial. When the nitrate is neutralized by a union with it of 
an equivalent of the constituents of the dentin, no further chem- 
ical action is possible. It is quite evident that no harm can re- 
sult to the tooth from proper application of this agent beyond 
the portion of it immediately acted upon. The nitrate can be. ab- 
sorbed by the dentin, but it stimulates the subjacent dentin to 
more healthy action." 

Silver nitrate applied to sound teeth as a so-called prophylactic 
measure — that is, a means of preventing dental caries — is freely 
indorsed in recent dental literature. As yet scientific proof has 
not been offered to substantiate such statements, and we are in- 



1 Brooks: American Journal of Dental Science, Vol. HI. 

2 Taft: Operative Dentistry, 1859, p. 214. 



CAUSTICS. 193 

clined to believe that such theories are based on false deductions. 
On sound enamel argentic nitrate has very little or no effect, while 
on cracked enamel, or on enamel of a tooth with a destroyed pulp, 
the silver salt has a better chance to reach the intercellular cement 
substance and combine with it. 

In "the course of human events" many of the pertinent clinical 
observations of the older writers have escaped recent investigators, 
and many contradictory theories have been promulgated regard- 
ing the action of silver nitrate on dentin. The late Harlan 1 has 
claimed that "when solutions of silver nitrate were used it was 
found not to penetrate the tubules to any extent, and it was 
classed as self-limiting with other coagulants. The silver nitrate 
furnishes its own stain, and the degree of penetration was easily 
denned in sections of the root." James Truman, 2 on the other 
hand, relates from his experiments: "The action of nitrate of 
silver in repeated tests was rather a surprise. It has generally 
been regarded as a superficial coagulant, but in every instance has 
proved deeply penetrating, and coagulating with rapidity and cer- 
tainty — very nearly equal to zinc chlorid." The foregoing dia- 
metrically opposed versions of the two investigators are due to 
the fact that their research work was conducted on teeth out of 
the mouth and in test tubes. Even taking for granted that phys- 
ical and chemic conditions could be established relatively equal 
to those in the mouth, there are other processes concerned in the 
maintenance of living tissue which can not, for the present at 
least, be supplements in the laboratory. Conclusions drawn from 
such experiments are often misleading, and they are of little prac- 
tical value. The first systematic investigation of the action of 
silver nitrate on dentin was conducted by Szabo, 3 of Arkovy's 
clinic in Budapest. Szabo approached this important problem 
in a more methodical manner. His experiments were conducted 
on the teeth in the living subject. The lower first molars, having 
central cavities, were selected for his experimental work, and the 
silver nitrate applied in 10, 20, 30 and 40-percent solutions and in 



1 Harlan: Dental Cosmos, 1898, p. 287. 

2 Truman: Dental Cosmos, 1895, p. 1. 

s Szabo: Osterreichisch-Ungarische Vierteljahrsschrift fur Zahnheilkunde, 1902, p. 42. 



194 



PHARMACO-THERAPEUTICS. 



the pure powdered state. The applications were repeated in some 
cases up to twenty-five times. In due time the teeth were ex- 
tracted. After decalcifying and fixing, microscopic sections were 
prepared and the following phenomena observed: The contents 
of the tubules are, up to a certain depth, destroyed, and small 
concrements, stained deeply black, in the form of debris, are seen. 
This debris is coagulated albumin, bacteria, etc., resulting from 
the action of the silver nitrate, which, on exposure to light, assumes 
a black color. The dense mass of coagulated silver-albumin 




Figure 14. 
Silver Nitrate Applied to Carious Dentin. Low power. (After Szabo.) 



checks the further action of silver nitrate. The penetration' of 
the silver salts into the diseased dentin is limited to about 1 / 50 of 
an inch; a further penetration could not be observed, no matter 
how strong and how often the application was renewed. On 
sound dentin the penetration was very superficial indeed. That 
part of the dentinal fibrils w T hich comes in direct contact with 
the silver salt is destroyed by coagulation, changing the semi- 
liquid protoplasmic contents of the tubules into a solid mass of 
silver-albumin, which, on exposure to light, becomes black and 



CAUSTICS. 195 

iasoluble. Beyond this line of demarcation the dentinal fibrils 
are not altered, but preserve their normal appearance. The action 
of silver nitrate on an albumin solution in vitro produces a dense 
silver-albumin, which in every respect corresponds microscopically 
to the above described precipitated contents of the dentinal tubules. 
From the foregoing facts we are forced to conclude that silver 
nitrate possesses a comparatively limited power of penetration into 
dentin ; it does not act deeply enough to endanger the vitality of 




Figure 15. 
Silver Nitrate Applied to Carious Dentin. High power. (After Szabo.) 

the dentinal fibrils, a conception which is held by Walkhoff, 
Miller, Szabo, and Preiswerck. 

Within recent years Stebbins 1 has strongly emphasized the 
value of silver nitrate as a means of permanently checking the 
progress of dental caries and as a prophylactic for the same dis- 
ease, especially in children. The same method has been repeatedly 
indorsed by Shanasy, 2 Frank, Niles, 3 and, recently, by Bryan. 4 



1 Stebbins: International Dental Journal, 1891, No. 10. 

2 Shanasy: Dental Cosmos, 1898, p. 876. 

3 Niles: L'Odontologie, 1900, No. 8. 

4 Bryan: Dental Review, 1903, No. 7. 



196 PHARMACO-THERAPEUTICS. 

Some practitioners have even gone so far as to speak of "restoring 
the softened dentin" by employing silver nitrate in substance, in 
concentrated solution, or in the form of filling materials. The 
early application of silver nitrate on those peculiar denuded tooth 
surfaces known as erosion is also much lauded. Shanasy, Con- 
rad, Preiswerck, and others have strongly favored such treatment. 
As a means of destroying the dental pulp, it has been employed 
in the very earty days of conservative dentistry, even many years 
before Spooner introduced arsenic for this purpose (1836). On 




Figure 16. 
Action of Silver Nitrate on Dentinal Fibrils. (After Szabo.) 

account of its self -limited action, it readily gave way to the 
promptly acting arsenic. Bethel 1 advocated the cataphoric appli- 
cation of silver nitrate for the sterilization of infected root canals. 
The many disadvantages of this treatment prevented its general 
acceptance by the profession. As a means of relieving the hyper- 
sensitiveness of dentin it is much praised by some practitioners, 
while others claim that it is very uncertain in its action. The 
black discoloration prohibits its use for such purposes on the an- 



1 Bethel: Ohio Dental Journal, 1896, No. 9. 



CAUSTICS. 197 

terior teeth. For the cauterization of aphthous growths in the 
oral cavity, the destruction of hypertrophic gum tissue and small 
tumors, and for similar purposes, it is frequently recommended. 
As a stimulating astringent and antiseptic, applied in various dilu- 
tions for the treatment of suppurative processes of the antrum 
and for so-called "dry sockets," it deserves praise. Cravens lauds 
it as the ideal medicinal application in the treatment of pyorrhea. 
Careful clinical observations have unquestionably proved that 
the thorough impregnation of a carious defect with silver nitrate 




Figure 17. 
Action of Silver Nitrate on Living Dentin. Cervical cavity. (After Szabo.) 

checks the further progress of this disease. Preiswerck 1 explains 
this phenomenon as follows: The favorable action of argentic 
nitrate on the course of caries may be explained by the insoluble 
combinations which it forms with the organic tooth substance, 
and thus withdrawing the nourishment from the bacteria. We 
may assume that the chemic process consists in the coagulation 
of the albumin and the formation of the albuminate of silver oxid. 
Furthermore, since the animal tissues always contain sodium 
chlorid, a chemic change occurs, in which the nitric acid of the 



1 Preiswerck: Atlas and Text Book of Dentistry, 1906, p. 219. 



198 PHARMACO-THERAPEUTICS. 

argentic nitrate combines with the sodium and the chlorin com- 
bines with the silver to form the insoluble silver chlorid: 

AgN0 3 +NaCl=AgCl+NaN0 3 . 

Miller 1 has proved, however, that this newly formed insoluble 
silver chlorid does not resist the action of acids in any marked 
degree, but that it is the solid mass of precipitated black silver 
albuminate which acts principally as the resisting force. This 
scientific explanation corresponds with clinical observations. 
Carious surfaces treated with silver nitrate which have not turned 
black do not resist the progress of caries, while the jet-black sur- 
faces are immune. Hence the significance of Black's 2 dogmatic 
postulate: "Expose the tooth surface treated with silver nitrate 
to sunlight for ten minutes until a full black color is obtained." 
The many offered substitutes for silver nitrate — silver lactate and 
citrate, or the colloidal silver and the organic silver compounds — 
are of little practical use for this work. 

Therapeutics. — Silver nitrate enjoys quite a reputation as a 
means of checking dental caries. In fact, it is the only chemical 
known so far which inhibits the progress of this disease. Its ap- 
plication is of special significance in the treatment of children's 
teeth. The various methods of application differ but little. The 
tooth is dried as much as possible and the softened decay is re- 
moved. The silver nitrate is applied in powder or crystal form, 
moistened with just enough water to form a solution, and left 
in contact from five to ten minutes. The stick form may be em- 
ployed for the same purpose; or blotting paper, according to 
Pierce, or, still better, asbestos felt, as suggested by Kirk, is 
saturated with a highly concentrated solution of the salt and 
sealed into the cavity. Holmes carries the powdered nitrate into 
the cavity on softened gutta-percha, while Dubois prepares a 
special gutta-percha according to this formula : 

Gutta-percha 5 parts. 

Zinc oxid 20 parts. 

Silver nitrate 2 parts. 

1 Miller: Dental Cosmos, 1905, p. 193. 

2 Black: Operative Dentistry, 1908, Vol. I. 



CAUSTICS. 199 

Much benefit results from the early application of silver nitrate 
on those peculiar denuded tooth surfaces known as erosion. At 
present we are not justified in giving a definite exposition of 
the etiology of erosion. Clinical experience has, however, demon- 
strated the fact that the process is checked by the silver applica- 
tion. The only objection is the deep-black color which it produces 
on decayed tooth structure. Bolten 1 advises the application of 
the silver salt in paste form on denuded tooth surfaces in the 
following manner: The gritty surface of a thin polishing strip 
is covered with the silver paste, placed about the tooth, and held 
in position by a thin metal clamp, or the strip is covered with a 

thin rubber cement. The paste is composed of : 

■ 
I£ Argenti nitratis 3 J (4.0 Gm.) 

Vaselini q. s. to make a stiff paste. 

Hypersensitive dentin resulting from carious defects or from 
senile atrophy of the alveolar bone is much benefited by the silver 



Figure 18. 
Adjustable Silver Nitrate Pencil. 

application. It is particularly useful for the treatment of exposed 
roots, especially of molars, which are frequently the source of 
severe acute pain as a result of the irritation brought about by cold 
or hot fluids. To apply the silver, the soft part should be pro- 
tected with a napkin, and the dry root is thoroughly impregnated 
with the caustic pencil or a concentrated solution. This treat- 
ment may be repeated if necessary. For the treatment of pyor- 
rhea pockets, Cravens advocates a 10-percent solution or the 
crystals melted on a platinum wire. A convenient way for ap- 
plying silver nitrate on the otherwise inaccessible places in the 
mouth consists in melting a few crystals into a bead on an iridio- 



1 Bolten: Berliner Zahnarztliche Halbmonatsschrift, 1908, p. 159. 



200 PHARMACO-THERAPEUTICS. 

platinum wire; the wire may be bent in any direction. In the 
treatment of shallow cavities or in cases of recession of gum tis- 
sue, the silver nitrate is best applied in concentrated solutions. 
Black describes his method as follows : It is best to dry the soft- 
ened area as deeply as possible Avith the warm air blast. Make a 
saturated solution by crushing a small crystal on a glass slab and 
adding a single drop of water. Apply this to the area of decay 
with the thin end of an orange wood stick and saturate the entire 
area thoroughly. If possible, expose the patient to the direct 
rays of the sun for ten to twenty minutes, and for inaccessible 
places reflecting the light by the mouth mirror will be of some 
service. In due time an intense black color is obtained. 

In deep-seated cavities which are still covered with a layer of 
cementum, and which reach beneath the gum tissue, silver nitrate 
is of less lasting benefit ; the precipitated silver albumin does not 
reach the dentin and in a few months it is washed away. 
Aphthous growths, small tumors, polypi, or hypertrophied gum 
tissues are readily destroyed by applying the silver in substance or 
in concentrated solution. A concentrated sodium chlorid solution 
should always be kept on hand to immediately check the silver 
application, if necessary. Extemporaneously, silver nitrate may 
be prepared for local application by dipping a silver wire into 
nitric acid. 

Toxicology. — Fatal results from poisoning with silver nitrate 
are rare, but nevertheless its use in the mouth requires caution. 
The caustic pencil may loosen from its holder and slip into the 
larynx; an accident of this nature has occurred and caused the 
death of a child. Common salt or ammonium chlorid are its 
chemic antitodes; they change silver nitrate into an insoluble 
silver chlorid. For internal treatment, lavage of the stomach 
with salt water and large draughts of milk or white of egg solu- 
tions are recommended. As sodium chlorid is irritating to the 
stomach, it should not be given in too concentrated solutions. 
In typical chronic poisoning (argyria) potassium iodid may be 
beneficial in aiding the elimination of the silver salts. Local 
argyria is sometimes met as a result of prolonged application of 
silver nitrate in the mouth, the eyelids, etc. Scheff describes a 



CAUSTICS. 201 

case of dental argyria in which the persistent application of the 
silver salt produced permanent stains on a number of teeth. 

Within recent years a number of compounds of silver with 
organic acids have appeared on the market, which for a short 
time were inclined to be considered equal in their action to silver 
nitrate. Prominently among these salts are silver citrate, known 
as Urol, and silver lactate, known as actol. Both salts were intro- 
duced by Crede. Silver citrate is a white powder, soluble in 
3,000 parts of water; it is nonirritating, and has been employed 
as a dusting powder on wound surfaces. Silver lactate, a white 
powder, is soluble in 15 parts of water ; it is caustic even in diluted 
solutions. Both silver salts and their solutions must be protected 
from light; they stain the tissues black. Silver acetate, another 
compound of this group, has never been employed therapeutically 
to any extent. Crede further recommended a form of colloidal 
silver known as collar gol — metallic silver in an extremely fine 
state of division, which is soluble in water and albuminoid fluids. 
It is usually applied in the form of an ointment. It was claimed 
that when collargol was introduced into the body by inunction or 
by intravenous injection, it would exercise a powerful germicidal 
influence. Actol and itrol possess only historical interest at 
present while collargol is still used and much lauded as a ser- 
viceable antiseptic in oral surgery. 

Argentamin is a protein silver compound, representing a solu- 
tion of silver phosphate in ethylendiamin. In preparing this 
compound it was hoped to increase the action of the silver by 
adding an alkali, which exercises a high solvent power on the 
cell wall of the micro-organisms. Theoretically this is correct, 
but it was found that the alkaline diamin proved to be too irritat- 
ing to the tissues. Largin, an albuminate of silver, and protargol, 
a protein silver compound, are among the more recent prominent 
silver preparations. Argonin, a casein-silver compound, appears 
as a white neutral powder, insoluble in cold, but freely soluble 
in hot, water. It is not precipitated by the tissue fluids, but 
cocain, eucain, and the heavy metals quickly reduce its solution. 
It is claimed that 15 grains of argonin contain as much silver as 
one grain of silver nitrate. It is used in 2 to 10-percent solutions. 
Albargol or albargin is a white, readily soluble powder, represent- 



202 PHARMACO-THERAPEUTICS. 

ing a gelatin-silver compound and containing 10 percent of silver. 
It is employed in 0.1 to 1-percent solutions. Still more recently 
a protein silver compound, which is stated to be silver vitellin, is 
known as argyrol It appears in dark-brown scales, tasteless and 
odorless, very hygroscopic, and very readily soluble in water. It 
is claimed to contain 30 percent of silver. It produces a super- 
ficial dark-brown stain, which is readily washed away; it has no 
cauterant effects on the tissues. It may be applied in substance 
or in aqueous solutions. Nargol, an organic compound of silver 
and nucleinic acid (yeast-nuclein), contains about 10 percent of 
silver; it is a brownish powder, and readily soluble in water. It 
is employed much in the same manner as protargol. Silverol, 
a phenolsulphate of silver, and argentol, a combination of silver 
with chinosol, are merely mentioned to complete the list. 

Some of these silver compounds have been recommended, as 
internal antiseptics in general septicemia, to be introduced hypo- 
dermically ; these attempts have not been successful. 

Of all the above named silver compounds, protargol is by far 
the most favored one. It is a light-yellow powder, containing 
about 8 percent of silver, very firmly bound to a protein body 
and very freely soluble in water. Owing to its firm combination 
with the metal, it produces no irritating effect on the tissues. It 
deserves recommendation as a powerful antiseptic for pus cavities. 
For irrigation of the maxillary sinus, weak solutions of from 1 / 2 
to 1 percent are employed, while for alveolar abscesses from 10 
to 20-percent solutions should be used. Solutions of protargol 
should always be freshly prepared with cold water and kept in 
a colored bottle; heat and light cause rapid oxidation of the 
solutions, which are then strongly irritating to the tissues. The 
following working formula is recommended for the preparation of 
a suitable solution : 

leJL Protargol. gr. v-xxx (0.32-2.0 Gm.) 

Glycerin. gtt. xv (1 Cc.) 

Sol. sod. chlorid. (0.9-percent) flg iv (120 Cc.) 
M. 

Sig. : Place the glycerin in a dry mortar, add the protargol, 
mix to a paste, and add the water in a slow stream with 
constant stirring. 



CAUSTICS. 203 

Arsenic Trioxid ; Arseni Trioxidum, U. S. P. ; Acidum 
Arseniosum, B. P.; As 2 3 . 

Etymology. — From the Greek arsenikon, which, however, 
designates what is known at present as orpiment or auripigment, 
or king's yellow, the native arsenic trisulphid. 

Synonyms. — Arsenous acid, arsenous anhydrid, arsenicum 
album ; acide arsenieux, F. ; Arsenige Saure, G. ; arsenico 
bianco, Sp. 

Source and Character. — Arsenous trioxid is not a true acid 
(absence of hydrogen) ; it is obtained by roasting arsenical ores. 
In Bohemia and Saxony it is largely produced from smelting crude 
cobalt ores, and in England from arsenopyrite, known as mis- 
pickel, or arsenical iron. It appears in transparent, porcelain-like 
masses; they change slowly to an opaque milk-white color or to 
a fine white powder. It has no taste or odor, and is entirely 
volatilized by heat. When thrown on ignited charcoal it emits 
a garlic-like (alliaceous) odor. It is slowly soluble in from 30 
to 100 parts of water at ordinary temperature, depending on the 
variety employed. It is completely soluble in 15 parts of boiling 
water and in about 5 parts of glycerin, and sparingly soluble in 
alcohol. It is incompatible with the salts of iron and magnesium, 
with lime water, and astringent vegetable drugs. 

Average Dose. — y 30 grain (0.002) Gm.). 

Preparations. — 

Liquor Acidi Arsenosi, U. S. P.; Liquor Arsenici Hydrochlor- 
ides, B. P. A 1-percent solution of arsenic trioxid acidulated with 
hydrochloric acid. 

Liquor Potasil Arsenitis, U. S. P.; Liquor Arsenicalis, B. P. 
Fowler's solution, a 1-percent solution of arsenic trioxid neutral- 
ized with potassium bicarbonate, and colored and flavored with 
compound tincture of lavender. Average dose, 3 minims 
(0.2 Cc). 

Liquor Arseni et Hydrargyri Iodidi, U. S. P., B. P. Donovan's 
solution, containing 1 percent each of arsenous iodid and red 
mercuric iodid. Average dose, l a / 2 minims (0.1 Cc). 

Medical Properties. — Antipyretic, antiseptic, alterative, and 
tonic. 



204 PHARMACO-THERAPEUTICS. 

Local and General Action. — If arsenic is applied to the un- 
broken skin, no change is produced, unless allowed to remain in 
close contact for some time. On denuded surfaces and mucous 
membranes it acts as a slow, but very persistent, protoplasm 
poison by powerful oxidation ; it does not form new compounds 
with the albuminous or protein materials of the cells. Arsenous 
trioxid does not, therefore, act as a caustic, nor is it self-limiting in 
its action. It has a predilection for necrobiotic tissue, producing 
true necrosis in due time. Taken internally, arsenic acts as a 
powerful irritant, resulting in vomiting, pain, and inflammation. 
It does not combine with the albuminous contents of the stomach 
or intestines, but remains unchanged. Thus it stimulates the 
nerves and vessels, and causes a sense of hunger by increasing 
the gastric functions. It is readily absorbed and quickly enters 
the blood. In overdoses, arsenic is extremely poisonous. It 
manifests itself in a feeling of constriction in the throat, in diffi- 
culty of swallowing, and violent pain ; "rice water" stools or 
bloody diarrhea, accompanied by diminished urine; cold, damp 
skin, together with giddiness, feeble pulse and respiration follow, 
soon ending in collapse. Chronic poisoning usually follows the 
prolonged absorption of small quantities, either from its thera- 
peutic use or from the presence of arsenic in the rooms in the 
form of dyes on wall paper, clothes, or in mines and factories. If 
arsenic is taken habitually in small quantities, a tolerance to the 
drug may be established, as with the arsenic eaters of Styria and 
the Tyrol. As much as seven grains have been taken without 
ill effects at a single dose by a person accustomed to its use. It 
is claimed that it will improve the complexion and general ap- 
pearance. 

Specific Action of Arsenic Trioxid on the Tooth Pulp. In 1833 
Wood advocated the use of crude arsenic (flystone, ratsbane, or 
native cobalt bloom) for the destruction of the dental pulp. 
Three years later, in 1836, Dr. Shearjashub Spooner, 1 of New 
York, published an excellent little book entitled "Guide to Sound 
Teeth, or a Popular Treatise on the Teeth," in which he recom- 
mended to the dental profession for the first time the use of 



1 Spooner: Guide to Sound Teeth, or a Popular Treatise on the Teeth, 1836. 



CAUSTICS. 205 

arsenic trioxid for the above purpose. "The nerves of the teeth 
may be certainly and effectually destroyed, with little or no pain 
to the patient and without the least danger, by means of a little 
arsenous acid applied to the nerve." Spooner claims to have 
learned this invaluable discovery from his brother, Dr. John R. 
Spooner, of Montreal, Canada. It is stated that Dr. Chaplin Har- 
ris, of Baltimore, used arsenic in 1835 without having knowledge 
of Spooner 's discovery. Arsenic was, however, utilized by den- 
tists for other purposes as early as the beginning of the Christian 
era, as recorded by Celsus in his work, "De Re Mediea." The 
Persian and Arabian physicians (Rhazes, Ebn Sina, Abulcasem, 
and others) frequently refer to the use of sandarach, the Arabian 
term for red sulphid of arsenic; in the form of a paste it was ap- 
plied about the roots of teeth to facilitate their ready removal. 

Spooner's announcement of the reliability of arsenic as a 
means of destroying the dental pulp met with violent opposition, 
and even as late as 1847 we read in Burdell - 1 "Suppose you 
have arsenic applied to the nerve of a tooth — it will act until its 
strength is wasted ; the action is toward the brain and spinal mar- 
row. It may destroy the nerve in the tooth and go on half way 
to the brain, or wholly to it, carrying death to the parts, which 
can never recover."' More broadminded men, however, like Dun- 
ning, Foster, Maynard, Westcott, 2 and others, strongly urged the 
advantages of arsenic over the old method of knocking out the 
pulp, or the slow-acting caustics — as silver nitrate, nitric acid, 
etc. — which were in vogue at that time. 

In 1885 Adolph Witzel 3 published his memorable work, "A 
Compendium of the Pathology and Therapeutics of the Diseases 
of the Pulps of the Teeth," in which he tried to explain the 
action of arsenic as follows: Arsenic acts on diseased parts of 
the pulp only, causing an increased influx of blood into the 
healthy parts. A deeper penetration of the drug through the 
entire pulp and through the foramen is excluded; no chemic dis- 
integration of the dentin takes place. Miller 4 studied the action 



1 Burdell: Teeth, Their Structure and Diseases, 1847. 

2 History of Dental and Oral Science in America, 1876. 

3 A. Witzel: Compendium der Pathologie und Therapie der Pulpakrankheiten, 1885. 

4 Miller: Lehrbuch der Konservativen Zahnheilkunde, 1906. 



206 PHARMACO-THERAPEUTICS. 

of arsenic on the pulps of teeth of dogs and rabbits, and on the 
tails of white mice. In some cases he placed a small glass ring 
over the tail, fastening it securely over its root, thus resembling 
somewhat the constricted apical foramen of the tooth. In other 
cases he encased the entire tail in a batter of plaster of Paris 
after previously applying a small amount of arsenic into a pouch 
under the skin. The most pronounced symptom in all cases mani- 
fested itself in an intense edematous swelling. The entire back 
and the hind limbs were involved, accompanied by pronounced 
anesthesia of these parts and paralysis of the legs, which results 
usually in twenty-four to thirty-six hours, depending on the quan- 
tity of arsenic used. Arkovy 1 presented a thorough investiga- 
tion of the arsenic before the International Medical Congress in 
London in 1801. A short resume of his work will be of greatest 
interest : 
^, According to the amount of arsenic used, a partial or total 
/ hyperemia of the pulp will be the result. The blood vessels 
enlarge and show signs of thrombosis, and embolism of the capil- 
laries may result. The red blood corpuscles lose their color 
most likely as a result of the chemic combination of the arsenic 
with the hemoglobin, causing anemic collapse and shrinkage. 
The connective tissue fibers and the odontoblasts are not changed, 
while the connective tissue cells are greatly enlarged. The axis- 
cylinders of the nerve cells usually disappear; the nerve cells 
themselves show a granular debris within the myelin. 

Other investigators followed. The writings of Herz-Frankl 
and Schenk, 2 Julius Witzel, 3 Morgenstern, 4 and Greve, 5 and the 
classic researches of Gubler, 6 on the therapeutic action of this im- 
portant drug are highly interesting. Binz and Schulz explain the 
pharmacologic action of arsenic trioxid as follows : When arsenic 
trioxid is absorbed by the living tissue, it is changed by the 
sodium present in the body fluids into sodium arsenite. and its 



1 Arkovy: Transactions International Medical Congress, 1881. 

2 Herz-Frankl und Schenk: Osterreichisch-Ungarische Vierteljahrsschrif t f iir Zahnheil- 
kunde, 1895, No. 2. 

3 J. Witzel: Correspondenzblatt fur Zahnheilkunde, 1898, No. 2. 

4 Morgenstern: Correspondenzblatt fur Zahnheilkunde, 1903, No. 1. 

5 Greve: Correspondenzblatt fur Zahnheilkunde, 1903, No. 4. 

6 Gubler: Commentaires Therapeutiques du Cotex, 1891. 



CAUSTICS. 207 

solution becomes ionized. The arsenic oxid ion, As0 3 , possesses a 
powerful reducing action on the tissues, changing it to an arsenate. 
The latter, in turn, is again reduced to an arsenite by the reducing 
action of the tissues. The perpetual oxidation and reduction 
within the cell causes a violent oscillation of the atoms of active 
oxygen, and this is the cause of its therapeutic and toxic effect. 
Within the cell proper, irritation is the immediate result, followed 
by cloudy swelling, fatty degeneration, and finally by necrosis. 
The metalloid arsenic merely plays the role of an autoxidizer. 
According to Filehne, all members of the arsenic-phosphorus- 
antimony group act very much in the same manner as arsenic 
trioxid. Arsenic trioxid is not a coagulant of albumin, or only 
very slightly so, and its action is practically unlimited; besides, 
the chemical is readily absorbed and very diffusible. These fac- 
tors are responsible for its deep action. 

The specific action of arsenic on the tooth pulp may be epito- 
mized as follows: If applied to a normal pulp, it is readily ab- 
sorbed. The endothelial coat of the capillaries is quickly cor- 
roded, causing multiple hemorrhage. Destruction of the blood 
plates immediately follows, resulting in granular detritus. 
Thrombosis and stasis are the direct sequences. The connective 
tissue fibers and the odontoblasts are but little altered. The pri- 
mary point of attack on the nerve centers is located in their 
endings, causing a destruction of the myelin and a more or less 
pronounced neuritis; the latter is usually followed by complete 
cessation of all pain. The pronounced disturbances of nutrition 
finally result in anemic collapse and shrinkage of the entire pulp 
mass. On pathologically altered pulps arsenic acts very much 
in the same manner, but decidedly slower, depending largely on 
the stage of inflamnration and the character of the exudates. An 
existing neuritis is always markedly increased. Depending on 
the vascularity and the size of the pulp, and the quantity used, 
from a few hours to two to five days are usually required for its 
progressive destruction. Strangulation of the pulp about its 
apical end, resulting from the action of arsenic, is not the direct 
cause of its death ; in teeth with undeveloped roots or in those with 
partially absorbed roots, strangulation is very doubtful. 



208 PHARMACO-THERAPEUTICS. 

Arsenic is not a caustic — that is, it does not cause a coarse 
chemic or physical alteration of the cell body; it is a true proto- 
plasm poison, its toxic action being based on a chemic reaction 
within the cell body proper. 

Therapeutics. — Since the introduction of arsenic trioxid for 
the purpose of destroying the dental pulp many substitutes have 
been advocated, but none have so far superseded it or taken its 
place. Crude arsenic, known as cobalt, 1 flystone, ratsbane, or by 
other synonyms, has been much lauded by such practitioners as 
Arthur, Allport, Taft, Herbst, Dorn, and others. It contains a 
very uncertain amount of arsenic, and possesses no advantage over 
the pure chemical. Aside from the use of local anesthetics by 
special methods, arsenic trioxid is still the most universal agent 
employed for the above purpose. Usually it is applied in the 
form of a paste, sometimes as arsenical fiber or discs, and as a 
dry powder. 

Innumerable formulas for compounds of arsenic with other 
drugs are suggested for dental purposes. The principal object has 
always been to combine the arsenic with an anesthetic. Many 
of the published formulas represent empirical compounds, which 
are put together in utter disregard of the pharmacologic action 
of the individual drugs. If the pulp is in a normal condition, 
very little or no pain is manifested by the arsenical application ; 
if the nerve cells are inflamed or are undergoing necrobiotic 
changes, the increased irritation brought about by the powerful 
oxidation and reduction as a result of the pharmacologic action 
of arsenic increases the already existing neuritis, and more or less 
severe pain results. Arsenic is very diffusible ; it quickly destroys 
the nerve endings, and consequently there is little chance for 
the anesthetic which may be added to it to exercise its specific 



1 Cobalt, chemically, is a metal of steel-gray color, hard, ductile, and of a high melting point, 
resembling iron in its general characteristics. It is rarely used in medicine. Unless specified, 
this metal cobalt is not sold in drug stores. A number of its compounds, consisting largely of 
cobalt in conjunction with arsenic, nickel, iron, manganese, etc., are found in nature, and are 
commonly called crude cobalt, cobalt ore, native cobalt-bloom, or simply cobalt. Metallurgists 
distinguish quite a number of cobalt varieties, according to their composition— as smaltine, 
tin-white or speiss cobalt, crude metallic arsenic, flystone or "Scherben cobalt," etc. (composed 
of about 70 percent of arsenic with cobalt, nickel, sulphur, etc.— a heavy, black powder, and 
usually sold by the name of "cobalt"), cobalt-bloom, erythrine or native cobaltic arsenate (with 

about 38 percent arsenic— a deep-blue powder) , cobalt-glance (with about 45 percent arsenic), 

earthy cobalt or wad (with no arsenic), etc. 



CAUSTICS. 209 

function. For this very reason it is questionable if the addition 
of a local anesthetic is of any benefit. For many years the original 
formula of Spooner, consisting of arsenic trioxid, morphin acetate, 
and creosote, has been and is still used with apparent good suc- 
cess. Morphin applied locally has no anesthetic or narcotic effect 
on sensory nerve endings, and consequently it acts merely as a 
diluent of the arsenic. Cocain or its substitutes, added to arsenic 
with the expectation of mitigating the pain or the irritating effect 
of the latter, is, to say the least, questionable. Scientific proof 
of this supposition has certainly never been brought forward. 
Nevertheless there is less objection to their use than to most of 
the other narcotics. Additions of aconite, eserin, opium or its 
salts, iodoform, etc., are useless, as they simply interfere with the 
ready absorption of arsenic. Thymol, menthol, the essential oils, 
etc., are painful anesthetics; their action is too slow to be of value 
in this connection. A more rational procedure consists in apply- 
ing to an aching pulp a concentrated solution of a local anes- 
thetic — cocain, novocain, etc. — prior to the introduction of the 
arsenical paste. The addition of an antiseptic to the arsenical 
paste is illogical. Arsenic is a powerful antiseptic in itself, 
although it is a well-known fact that the cell walls of the lower 
organisms (bacteria) possess a greater resistance to its action than 
those of the higher organized cells. Tanning agents are fre- 
quently added to the paste for the purpose of changing the pulp 
tissue to a leathery material, so as to facilitate its ready removal. 
Tannic acid or the various forms of formaldehyd are useful for 
this purpose. It is better practice to apply such agents after the 
arsenic dressing has been removed; the less we interfere with the 
absorption of the arsenic, the better and quicker will be the 
results. 

As a vehicle for the paste, only such media as are more or 
less solvents of arsenic, and which allow ready absorption by the 
pulp, are justified. Glycerin is preferable to any other medium. 
Lanolin, a natural wool fat, has been recommended; it, however, 
prevents the ready absorption of the paste. Phenol, creosote, or 
the essential oils, and similar liquids, have been used for many 
years as vehicles for the paste; their influence on the action of 



210 PHARMACO-THERAPEUTICS. 

arsenic is apparently of very little consequence ; they certainly do 
not exercise their typical pharmacologic action in this connection. 
Strong coagulants should not be 'used, as they hinder the ready 
absorption of the poison by forming a scab. 

To give a distinct color to the paste, very small quantities of 
lamp black or carmin may be added. Some practitioners prefer 
to apply arsenic in the form of a paste mixed with cotton fibers, or 
in the form of paper discs saturated with a soft paste. Arsenical 
fiber is prepared by mixing cross-cut cotton with the paste, and 
the discs are made by saturating very small squares of hard white 
blotting paper with the thin paste, which are then dried and pre- 
served. 

Prior to the application of arsenic, the cavity should be ex- 
cavated, and, if possible, the pulp should be thoroughly depleted, 
either by puncturing the organ or by producing artificial anemia. 
Szabo 1 recommends lavage for this purpose — washing the pulp 
with lukewarm water, changed sloAvly to cold water. Quicker re- 
sults are, however, obtained by applying adrenalin chlorid solu- 
tion under pressure. The cavity must be free from blood, to pre- 
vent the formation of inactive arsenic hemoglobin. If the pulp 
is inflamed and painful, it is absolutely necessary to apply suit- 
able remedies to relieve the conditions before the paste is applied ; 
an inflamed pulp materially hinders the ready absorption of ar- 
senic, and continuous severe pain is certain to follow. A mixture 
of tannic acid, cocain hydrochlorid, and liquid phenol is service- 
able for this purpose. According to Jack, 2 a weak solution of 
formaldehyd is very effective. These remedies, if sealed into the 
cavity, usually alleviate the condition in from twenty-four to 
forty-eight hours. If pus is present, it must be drained off, and 
washed away with a mild, warm antiseptic solution. Pulp nodules 
occasional^ obstruct the ready diffusibility of the chemical. Re- 
moval of these calcareous deposits by means of sulphuric acid or 
by a drill, after cocain pressure anesthesia has been applied, is 
indicated. Cocain should never be applied cataphorically under 
these conditions, as the electric current will drive the previously 



1 Szabo: Osterreichisch-Ungarische Vierteljahrsschrif t fur Zahnheilkunde, 1903, No. 2. 

2 Jack: Kirk's Operative Dentistry, 1900, p. 189. 



CAUSTICS. 211 

applied arsenic through the apical foramen into the soft tissues. 
Fletcher 1 reports a case of this nature, resulting in severe inflam- 
mation of the pericementum. Bitter 2 warns against the applica- 
tion of arsenic during pregnancy, claiming that the teeth are less 
resistant and softer. Occasionally one meets a patient who pre- 
sents an unexplained idiosyncrasy to the action of this chemical. 
The cavity for the reception of the arsenical application should 
be of ready access, and so prepared as to easily retain the tem- 
porary filling. The arsenical compound is preferably placed in 
direct contact with the freely exposed pulp by means of a blunt 
instrument, or on a depressed metallic disc or a piece of cardboard, 
or on cotton or spunk. Close contact insures quick action. Ar- 
senic will act by osmosis, although slower, through any thickness 
of dentin. This very fact is the reason its use as a remedy for 
hypersensitive dentin has been abandoned ; death of the pulp was 
invariably the sequence of such a procedure. Some operators pre- 
fer to cover the arsenical dressing with an intermediate film of 
plain or oiled paper, or a pledget of cotton. The final sealing of 
the cavity consists of a temporary filling of cement or of a gutta- 
percha preparation. Extreme care should be exercised in this 
simple, yet most important, operation. Cotton fibers mixed with 
sandarac or mastic varnish, to be used as a retaining medium, 
should be avoided; they readily become foul in the fluids of the 
mouth, or they may leak, and, besides, they swell, causing pain 
from pressure on the pulp. Kirk has advocated the use of sur- 
geon's rubber plaster where but a portion of the tooth is left, 
carrying it around the tooth; it will adhere satisfactorily for 
several days, or long enough to accomplish the object. The gutta- 
percha preparations are the best media for a temporary dressing 
seal; most experienced operators agree that a cavity correctly 
sealed with this material offers less possibilities for the seeping 
through than the various cements or other materials. In Europe 
Fletcher's artificial dentin is used universally for such work. 
In applying the temporary stopping, it is very essential to avoid 
pressure on the dressing. In approximal cavities, where over- 



1 Fletcher: Ohio Dental Journal, 1891. 

2 Ritter: Zahn und Mundleiden, 1899. 



212 PHARMACO-THERAPEUTICS. 

hanging tooth substance prevents ready access, and therefore pre- 
sents danger of misplacing the arsenical dressing, gutta-percha 
packed between the two teeth, and thus acting as a splint, is of 
service. 

The quantity of arsenic necessary for the destruction of a pulp 
is very small. A careful estimation has shown that the average 
mature pulp requires about 1 / 30 grain (0.002 Gm.) for its com- 
plete devitalization. It is not only useless, but decidedly danger- 
ous, to employ more. According to A^on Metnitz 1 the same little 
pellet, charged with an arsenical paste, which had killed suc- 
cessively sixteen pulps, still retained enough arsenic to cause 
necrosis in the leg of a frog. 

In deciduous teeth, and in those of young persons where the 
roots have not fully formed, the arsenical paste should be left in 
the cavity only a very short time. To illustrate the danger of 
arsenic used on such teeth, Martin 2 reports the following case 
in which he applied the paste on the pulp of a lateral incisor: 
"The devitalization agent passed out through the apical opening, 
as sloughing is most marked at the apex, and the apical opening 
in the tooth was noticed to be abnormally large." Many prac- 
titioners are opposed to its use in the teeth of children. More 
than two teeth should not be subjected to the treatment at one 
sitting, to prevent a possible chance of an accidental swallowing 
of a large amount of the poison. 

The time required for the destruction of the pulp with arsenic 
depends on many circumstances. In the young, on account of 
the great vascularity of the organ, from four to eight hours are 
usually sufficient. In people of mature age it is best to leave 
the application in situ from three to four days. This allows 
ample time for the breaking down of the entire pulp and its rami- 
fications. Many pulps do not, however, require more than one 
or two days to succumb to the effects of the poison. After the 
arsenic has been removed it is well to apply some astringent drug, 
such as tannic acid or formal dehyd, for one or two days, which 
will greatly facilitate the ready removal of the pulp in toto. Occa- 



1 Von Metnitz: Lehrbuch der Zahnheilkunde, 1903. 

2 Martin: Dominion Dental Journal, Vol. XIV. 



1 



CAUSTICS. 213 

sionally it will be found that, on the removal of the organ, the 
apical half is still very sensitive to the touch. If it becomes neces- 
sary to again apply arsenic in the root canal, a very small quan- 
tity of the paste carried on the end of a barbed broach, which is 
quickly thrust into the pulp stump, should be employed. 

The following important factors should be remembered when 
an arsenical compound is used for the purpose of destroying the 
pulp : 

1. Only the smallest possible quantity which will kill the pulp 
should be used. 

2. Arsenic should never be applied on a seyerely aching pulp. 

3. On teeth with partially absorbed or with undeveloped roots 
the arsenical paste should remain only from four to eight hours. 

4. In fully developed teeth the paste may remain from one to 
four days. 

5. If possible, the paste should be applied on a freely exposed 
and depleted pulp. 

6. The retaining seal must be applied without pressure and 
with the utmost care. 

Toxicology. — If arsenic is swallowed in an overdose — 2 grains 
(0.12 Gm.) are known to have killed a man — the proper antidotes 
should be promptly administered. Vomiting should be induced 
by the finger, the feathery part of a quill, or by an emetic. The 
official arsenic antidote — freshly prepared ferric hydrate with 
magnesia — given in tablespoonful doses every five or ten minutes, 
or dialysed iron followed by common salt, are the best means of 
chemically neutralizing the poison. 

Local toxic effects of arsenic in the mouth are most frequently 
met with as the result of faulty application of the chemical for 
dental purposes. Leakage of the dressing seal is responsible in 
most cases, and contact of the mucous membrane with "instru- 
ments accidentally carrying small particles of the paste, or the 
unnoticed squeezing out of arsenic resulting from pressure ap- 
plied on placing the retaining stopping, are possible factors. The 
fact that arsenic trioxid is odorless and tasteless increases this dan- 
ger, which is usually recognized only after the mischief is done. 
A number of cases of severe forms of toxic periostitis, followed by 



214 PHARMACO-THERAPEUTICS. 

necrosis of the alveolar process, and consequent loss of one or 
more teeth, are on record. 

Peso 1 relates a case in which arsenic applied to a lower left first 
molar caused destruction of the alveolar process and gum tissue 
ranging from the first bicuspid to the second molar. Close in- 
vestigation revealed a minute perforation of the distal root. 
Faught 2 reports a number of local arsenical intoxications result- 
ing from the application of a rubber dam which was ndt washed 
prior to its application. An examination developed the fact that 
the French chalk (soapstone) used for preserving the dam con- 
tained sufficient calcium arsenite to produce the affection. Pow- 
ers 3 described a peculiar arsenical intoxication which resulted in 
the loss of the entire lower denture. The local poisoning was 
brought about by frequently cleansing the teeth with yarn which 
had been dyed with colors containing arsenic. In the early days 
of the use of arsenic in dentistry it was customary with many 
practitioners to place a permanent filling directly over the ar- 
senical dressing without making an effort to remove the pulp. 
Usually within five years one-half of the teeth treated in this man- 
ner were lost as a result of alveolar abscesses or of toxic pericemen- 
titis. Coleman-Cunningham 4 went so far as to recommend a 
weak solution of arsenic in alcohol and oil of cloves as a pre- 
servative of pulp stumps left in inaccessible root canals, such 
treatment naturally always resulting in the loss of the tooth. 

Kiihns 5 reports a case in which the pulps of three molars died, 
accompanied by pericemental intoxication, as, a result of large 
amalgam fillings; an analysis of the amalgam ^alloy showed that 
it was made from impure metals containing arsenic. The latter 
is frequently found as a persistent impurity in commercial tin 
and zinc. Prolonged retention of arsenic in a tooth may also re- 
sult in intoxication of the pericementum. Preiswerck 6 has shown 
that arsenic may penetrate through the dentinal tubules and 
the cementum, but it rarely passes through the entire pulp and 



1 Peso: Dental Cosmos, 1903, No. 5. 

2 Faught: Course in Dental Pathology, 1885. 

3 Powers: Dental Brief, 1902, No. 11. 

4 Coleman-Cunningham: In Hollander, Arzneimittellehre, 1890. 

5 Kiihns: Deutsche Zahnarztliche Wochenschrift, 1908. 

6 Preiswerck: Osterreichisch-Ungarische Vierteljahrsschrift fur Zahnheilkunde, 1901, No. 2. 



CAUSTICS. 215 

through the foramen. Dental cements containing traces of ar- 
senical compounds are known to have destroyed the pulp. It has 
been argued that the death of a pulp under a cement filling is the 
result of the irritating action of free phosphoric acid or of zinc 
chlorid. While this may be correct, it is nevertheless proved by 
chemic analysis that the powder of a modern so-called silicate 
cement contained sufficient arsenic to be the cause of death of 
many pulps. Recent improvement in the manufacture of this 
cement has eliminated the presence of the arsenical impurity. 

Boening 1 presented a case at the Garretson Hospital of a child 
for whom an arsenical application had been made to a deciduous 
molar. The arsenic had been placed in the tooth for the purpose 
of devitalizing the pulp, but the supposed pulp did not exist. The 
arsenic so affected the surrounding tissue that, according to his 
explanation, paralysis of the parts ensued, and a general break- 
down of the entire soft tissue of the lower jaw followed, involving 
some of the hard tissues. Gangrene set in, and the child's life 
was despaired of. By heroic methods the child was carried along 
between life and death for several days beyond the danger line, 
and the operation performed later on. 

In all cases where arsenical poisoning of the alveolar tissues is 
suspected, and where proof is demanded for legal testimony, a 
careful differential diagnosis should be made between arsenical 
necrosis and bacterial infection, diabetic gangrene, or arterio- 
sclerotic disturbances. To test for the presence of arsenic, the 
gathered and dried necrotic tissue is placed in a bulb tube with a 
dry mixture of sodium carbonate and potassium cyanid. The 
bulbar end is heated until fusion takes place, when, if arsenic is 
present, a metallic arsenic mirror will appear in the constricted 
area of the tube. Another test may be made by mixing the sus- 
pected substance with sulphuric acid in a test tube. To 3 cubic 
centimeters of the mixture add a solution of iodin until a yellow 
color appears, and then add a few pieces of zinc. After inserting 
a loose cotton plug into the tube, cover the mouth with a piece 
of white filter paper, the center of which has been moistened with 
a drop of concentrated solution of silver nitrate. If the moistened 



1 Boening: The Stomatologist, 1905. 



216 PHARMACO-THERAPEUTICS. 

spot becomes yellow immediately or after some time, or if the spot 
becomes black or brown at its periphery, arsenic is surely present. 

Arsenical intoxication of the gum tissue presents in its early 
stages all the phenomena of true inflammation. Later the sur- 
faces become denuded and assume a raw ham color ; the veins are 
distended, the border of the infected area is raised and shows a 
loss of substance in the depressed center — the typical picture of 
an ulcer. Usually there is a pronounced metallic taste present in 
the mouth. Arsenic penetrates very deeply, destroying the soft 
and hard tissues, which finally results in true necrosis. In the 
early stages the affection is not painful, but, as soon as the deeper 
structures are reached, severe pain is manifested. 

The treatment depends on the severity of the poisoning. Simple 
intoxication requires the immediate removal of the cause and mild 
antiseptic mouth washes. If necrosis has set in. the affected 
parts must be thoroughly curetted with a large spoon excavator: 
if the bone has sequestered, it must be removed. Local anesthesia 
is usually serviceable for such work. The denuded surface is 
dusted with a mixture of orthoform and corn starch. 1 to 4. If 
sequestration of the alveolar bone continues, the application of 
aromatic sulphuric or phenolsulphonic acid will be of great 
assistance in detaching the dead bone. A bland antiseptic used 
warm and at frequent intervals is indicated as a mouth wash. The 
local application of dialyzed iron or solution of iron chlcrd as 
arsenical antidotes is indicated only if arsenic is present in rjb- 
stance on the tissues; after it is absorbed, these solution? *»*e 
useless. 

Devitalizing Compounds. 

J$l Arsen. trioxid. gr. xxx (2.0 Gm.) 

Novocain. gr. xx (1.3 Gm.) 

Glycerin. q. s. to make a paste 



J$l Arsen. trioxid. 

Cocain. hydrochlorid. aa gr. xx (1.3 Gm.) 

Menthol. gr. v (0.3 Gm.) 

Glycerin. . q. s. to make a paste 



(Kirk.) 



HEMOSTATICS AND STYPTICS. 217 

I£ Arsen. trioxid. 3 J ( 4 -° Gm -) 

Cocainae gr. xx (1.3 Gm.) 

Menthol. gr. v (0.3 Gm.) 

Lanolini q. s. to make a paste 

Sig. : A sufficient amount of lampblack should be added to 
color the paste. 

(Buckley.) 

}$l Arsen. trioxid. 

Cocain. hydrochlorid. aa gr. xx (1.3 Gm.) 

01. caryophyl. q. s. to make a paste 

(Miller.) 

Devitalizing Fibers. 

IJl Arsen. trioxid. gr. v (0.3 Gm.) 

Acid, tannic. gr. ij (0.12 Gm.) 

Morphin. acetat. gr. x (0.65 Gm.) 

Phenol, liquefact. q. s. to make a thin paste 

Sig. : Fine cross-cut absorbent cotton fiber is mixed with 
this paste and dried. 

(Flagg.) 

Devitalizing Discs. 

$. Arsen. trioxid. 

Cocain. hydrochlorid. aa equal parts 

01. caryophyl. q. s. to make a thin paste 

Sig. : Cut small squares (one to one and one-half milli- 
meters) of hard white blotting paper, saturate with the 
paste, let dry for a few hours and then put into a glass- 
stoppered bottle. 

(Burns.) 



HEMOSTATICS AND STYPTICS. 

Hemostatics and styptics are agents which arrest the flow of 
blood from a broken vessel wall — that is, hemorrhage. At pres- 
ent both terms are nsed analogously. The older medical lexicog- 
raphers restricted the term "hemostatic" (to make the blood 
stand still) to drugs administered internally for the above pur- 
poses, while the term "styptic" (to tie up) was reserved for ma- 
terials which were locally applied. 

Remedies which are applied for the purpose of checking hemor- 
rhage are logically divided into : 



218 PHARMACO-THERAPEUTICS. 

1. Those which are administered internally and of which a 
general action on the circulation is expected. 

2. Those which possess a definite local action when applied on 
the broken vessel wall. 

The action of the true hemostatics is expected to manifest itself 
in three definite ways: 

1. To coagulate the blood at the point of its exit from the 
broken wall. 

2. To contract the vessel locally. 

3. To reduce, if possible, the blood pressure within the region 
of the affected part. 

The seat and the nature of the hemorrhage controls largely 
the means of its treatment. Hemorrhage from large vessels is 
always controlled preferably by mechanical means — as ligatures, 
torsion, tamponing, or by the actual cautery — while small ex- 
ternal bleedings are often readily checked by the direct applica- 
tion of drugs which act as true hemostatics. Complete immobi- 
lization of the part and perfect rest of the patient, with abstinence 
from liquid food, especially alcoholics, is of marked benefit. 

In accordance with the nature of their action, hemostatics are 
closely related to astringents, protectives, and caustics. For the 
sake of convenience, they may be divided as follows: 

1. Absorbents. Purified cotton, styptic cotton, styptic collo- 
dion, matico leaves, spunk, penghawar djambi, the old-fashioned 
use of cobweb, and many indifferent powders — starch, talc, pow- 
dered charcoal, etc. These materials form a glue-like protective 
scab over the broken vessel wall. 

2. Caustics and astringents, (a) Metallic salts — zinc chlorid, 
silver nitrate, potassium permanganate, iron chlorid, iron sub- 
sulphate, alum, etc., and all acids sufficiently diluted so as not to 
cauterize; concentrated solution of hydrogen dioxid may be 
classified under this heading, (b) Tannic acid, or its various 
modifications. 

3. Agents tvhich act after being absorbed into the circulation. 
Gelatin solution, calcium chlorid, calcium lactate, etc. 

4. Agents which act on the vessels, but not on the blood. 
The alkaloid of the suprarenal capsule, hydrastinin hydrochlorid, 



HEMOSTATICS AND STYPTICS. 219 

stypticin, styptol, etc. These drugs act as vasoconstrictors. The 
smooth muscular coat of the blood vessels is constricted by the 
direct action of drugs in two ways — either by their external appli- 
cation, or by their absorption through the blood current. 



Absorbents. 

Purified (Absorbent) Cotton; Gossypium Purificatum, 

U. S. P. 
The hairs of the seed of the cotton plant, which are freed from 
adhering impurities and deprived of fatty matter. 

Styptic Cotton; Gossypium Stypticum. 

Absorbent cotton saturated with various styptic solutions — solu- 
tion of salts of iron, alum, stypticin, styptol, etc. 

Styptic Collodion; Collodium Stypticum, U. S. P. 
A solution of tannic acid, 20 parts, in diluted collodion, enough 
to make 100 parts. 

Penghaavar Djambi ; Golden Moss. 

The long silky, yellowish, very soft hairs from the base of 
strips of certain tropical ferns. Penghawar djambi is the Malayan 
name of the drug. 

Caustics and Astringents. 

Solution of Iron Chlorid; Liquor Ferri Chloridi, U. S. P. 

An aqueous solution of ferric chlorid, containing about 29 parts 
of the anhydrous salt. It is a reddish-brown liquid, having a 
faint odor of hydrochloric acid and an acid, strongly styptic taste. 
Average dose, ly 2 minims (0.1 Cc). 

Strong Solution of Iron Perchlorid; Liquor Ferri Per- 

chloridi fortis, b. p. 

It is a solution of iron chlorid in water, containing about 22.5 
percent of iron. It is an orange-brown liquid, with a strong acid 



220 PHARMACO-THERAPEUTICS. 

and styptic taste: miscible with water and alcohol in all pro- 
portions. 

Solution of Ferric Subsulphate: Liquor Ferri Subsul- 

phatis, U. S. P. 

Monsel's solution ; solution of iron persulphate. An aqueous 
solution of basic ferric sulphate. It is a dark reddish-brown 
liquid, odorless or nearly so, of an acid, strongly styptic taste and 
an acid reaction. Average dose, 3 minims (0.2 Cc). 

Iron Subsulphate; Ferri Subsulphatis. Monsel's powder or salt ; 
ferric subsulphate or persulphate. A yellowish hygroscopic pow- 
der, readily soluble in water and of an astringent, styptic taste. 
It should be kept in well-stoppered bottles. Average dose. 3 
grains (0.15 Gm.). 

F err (pyrin : Ferropyrin. A reddish crystalline powder, con- 
taining 64 parts antipyrin, 12 parts iron, and 24 parts chlorin. 
It is readily soluble in water. It is applied in substance or in 
10 to 50-percent solutions. 

The above mentioned iron preparations should not be used in 
the mouth as styptics; they are caustic, and form a dirty, black 
coagulum with the blood and the lacerated tissues. 

Alum; Alumen, U. S. P., B: P.; A1K(S0 4 ) 2 +12H 2 0; Alu- 
minium and Potassium Sulphate. 

Large colorless crystals, without odor, and having a sweetish 
and strongly astringent taste. Soluble in 9 parts of water at 
ordinary temperature or in 0.3 parts of boiling water. Readily 
soluble in warm glycerin, but insoluble in alcohol. Average 
dose, 7V 2 grains (0.5 Gm.). 

Exsiccated Alum ; Alum Exsiccatum, U. S. P. ; Alumen 

Ustum, B. P. 

Dried or burned alum. A white granular powder, without 
odor, having a sweetish, astringent taste. It is soluble in about 
20 parts of water at ordinary temperature and l 1 / 2 parts of boiling 
water, it readilv absorbs moisture from the air. 



HEMOSTATICS AND STYPTICS. 221 

Agents Which Act After Being Absorbed Into the Cir- 
culation. 

Gelatin; Gelatinum, U. S. P. 

The purified air-dried product of the hydrolysis of certain ani- 
mal tissues — as skin, ligaments, and bones — by treatment with 
boiling water. It is found in more or less transparent, solid, thin 
sheets, or shredded; it is odorless and colorless. It is unalterable 
in the air when dry, but putrefies very rapidly when moist or 
in solution. As a hemostatic it is used in 5 to 10-percent solu- 
tions, using physiologic salt solution as a solvent. They must 
be heated so as to liquefy the solution, ready for use. Ex- 
treme care is necessary to use a perfectly sterile solution ; cases 
are on record in which tetanus has developed as a sequence of an 
infected solution. Gelatin contains lime salts, and it is probable 
that this latter fact has something to do with the ready coagula- 
tion of the blood when gelatin is injected, as lime salts have 
a definite influence on the ready formation of the blood clot. 

The injection or internal administration of soluble lime salts, 
especially in hemophilia, has been tried with good results. Cal- 
cium chlorid and calcium lactate are serviceable for such pur- 
poses. In severe dental hemorrhage the following combination 
may be tried : 

Ifc Calcii lact. 5 jss (6.0 Gm.) 

Syrup, aromatic. fl§ j (30 Cc.) 

Aquae destill. Ag iij (90 Cc.) 

M. 

Sig. : Tablespoonful every two hours. The whole quantity 
should be taken within twenty-four hours. 

Agents Which Act on the Vessels, But Not on the 

Blood. 

Solution of Adrenalin Chlorid, 1 .1,000. 

This solution is used undiluted for external application, or by 
means of intra-parenchymatous injections, 1 :10,000 or 1:20,000. 
As a hemostatic for dental purposes it is of questionable value, 
but as an addition to local anesthetics on account of its vaso-con- 
strictor action it is very important. 



222 PHARMACO-THERAPEUTICS. 

Hydrastinin Hydrochlorid; Hydrastinin^e Hydrochloridum, 

U. S. P. 

A light-yellowish crystalline powder, odorless, and of a very 
bitter taste, prepared from an artificial alkaloid derived from 
hydrastin ; the latter is obtained from golden seal, hydrastis cana- 
densis, U. S. P., B. P. It is very soluble in cold and hot water. 
Average dose, v / 2 grain (0.03 Gm.). 

Stypticin; Cotarnin Hydrochlorid. 

A product of oxidation of narcotin. A lemon-yellow powder 
or crystals, having a bitter taste. It is soluble in water and alco- 
hol. Externally it is applied in substance or in concentrated 
solutions, and internally in tablets or in gelatin capsules. Aver- 
age dose, 8 / 4 grain (0.04 Gm.). 

Styptol; Cotarnin Phthalate. 

A lemon -yellow, very fine crystalline powder > which is very 
readily soluble in water. It is applied externally in substance or 
in concentrated solution, and internallv in susfar-coated tablets 

/ %j CD 

or gelatin capsules. Average dose, 3 / 4 grain (0.04 Gm.). 

Ergot in the form of the fluidextract, the solid extract, the 
various alkaloids, and many other forms is recommended as an 
internal hemostatic. It is especially applicable in hemorrhage of 
the uterus. 

Potassium Permanganate in 5 to 10-percent solutions acts as 
a strong styptic. A paste made of the salt with charcoal and 
vaselin is known as styptogan. 

Zinc Chlorid in 1 to 5-percent solutions is a powerful styptic, 
which may act even through the vessel wall. Its application is 
painful. 

Lemon Juice and Ordinary Vinegar are frequently employed 
by the laity as styptics. 

Chromic Trioxid in 10 to 50-percent aqueous solutions acts as 
a powerful styptic. Its application requires great care. 

Hydrogen Dioxid in 3 to 5-percent solution is a mild styptic ; 



PROTECTIVES, DEMULCENTS, AND EMOLLIENTS. 223 

the 25-pereenl ethereal solution, pyrdzon, and the 80-percent 
aqueous solution, perhydrol, are very powerful styptics. The 

latter solutions must be used with great caution. 

Tannic Acid, which is the active constituent of all vegetable 
astringents, will quickly coagulate the blood if applied in sub- 
stance or in concentrated solution. For smaller hemorrhage the 
glycerite of tannic acid is useful. Since the introduction of cer- 
tain artificial alkaloids — stypticin and styptol — tannic acid has iosl 
much of its repute as a hemostatic. 

PROTECTIVES, DEMULCENTS, AND 
EMOLLIENTS. 

Protectives are agents which are employed for the purpose of 
mechanically covering sensitive, wounded, diseased, or otherwise 
defective body surfaces, including the mouth, against external 
insult>. 

Demulcents, sometimes referred to as vehicles, are usually col- 
loidal, oily, or albuminous substances, which are employed for the 
purpose of mechanically covering sensitive, wounded, diseased, or 
otherwise defective mucous surfaces against further insults. They 
are closely related to protectives and emollients. Demulcents are 
often given internally to envelop nauseous, ill-tasting medicines, 
or to give body to watery solutions of drugs which are used in 
large quantities; they retard the absorption of drugs. Oleo-resins, 
balsams, oils, and other substances insoluble in water are usually 
administered in aqueous mixtures in which the minute droplets 
are held in suspension in the form of an emulsion by means of 
acacia or tragacanth. 

Emollient*, sometimes referred to as protectives. are bland, oily 
substances which are employed externally to protect the skin, the 
surfaces of a wound, or the otherwise denuded epidermis from 
irritation by the air or other mechanical disturbances. Their 
action is purely local; they render the skin soft and more pliable. 
A drug, when applied to the skin, is more quickly absorbed when 
dissolved in an emollient, as it readily mixes with the sebaceous 
matter which covers the external epithelium. Animal, vegetable, 



224 PHARMACO-THERAPEUTICS. 

and, recently, mineral fats and oils are used for such purposes. 
Simple mechanical protectives, which have no medicinal action, 
are also classified as emollients. 

Rubber ; Elastica, U. S. P. ; Caoutchouc ; India Rubber ; 
Caoutchouc, F. ; Kautschuk, G. 
It is the prepared milk juice of several species of the family 
Euphorbiace.fe, and is commercially known as Para rubber. Rub- 
ber forms the base of many important preparations. AVhen mixed 
with sulphur and subjected to a high heat under pressure, it is 
known as vulcanized rubber or vulcanite. Vulcanite is largely 
used in the arts, in medicine, and in dentistry in the form of 
bandages, drainage tubes, catheters, bags, instruments, etc. It 
is an important adjunct to surgical practice, while dentistry em- 
ploys vulcanite chiefly as a cheap and reliable base for artificial 
dentures and in the form of rubber dam (coffer dam) as a means 
of excluding moisture from the teeth during operations. Para 
rubber is also largely used for the preparation of adhesive and 
other plasters. 

Gutta-Percha ; Gutta-Percha, B. P.; Gutta-Percha, F., G. 

It is the concrete milk juice of Palaquium gutta and allied plants. 
The purified gutta-percha is a white, odorless, and tasteless inert 
mass, which readily softens by the application of heat. It forms 
the base of many important preparations — tooth filling materials, 
surgical splints, and other appliances of a similar nature. A 10-per- 
cent solution of purified gutta-percha in chloroform is known 
as traumaticin, and is used in Europe as a substitute for collodion ; 
it forms an excellent protective seal over small wounds in the 
mouth. In the form of chloro-percha it is largely used as a root 
canal filling. 

Many resins — as sandarac, mastic, copal, dammar, shellac, rosin, 
etc. — in alcohol or ethereal solutions are employed in dentistry 
for mechanical and surgical purposes. 

Collodion; Collodium, U. S. P., B. P.; Collodion, F. ; 

Collodium, G. 

It is a solution of pyroxylin (colloxylin, gun-cotton) in a mix- 



PROTECTIVES, DEMULCENTS, AND EMOLLIENTS. 225 

ture of ether and alcohol. A very concentrated collodion in dry 
form is known as colloidin. Collodion should be kept in a well- 
corked bottle, protected from light and fire. 

Flexible Collodion; Collodium Flexile, U. S. P., B. P. It is 
ordinary collodion with the addition of small quantities of Canada 
turpentine and castor oil to make it more flexible. 

Compound Tincture of Benzoin; Tinctura Benzoini Composita, 
U. S. P., B. P.: Turlington's Balsam; Friar's Balsam; Jesuits' 
Drops. It is an alcoholic solution of benzoin, aloes, storax, and 
balsam of Tolu. 

Paraffin ; Paraffixum, U. S. P. : Paraffixum Durum, B. P. : 
Paraffins, F. ; Paraffin, G. 

A solid mixture of hydrocarbons, without odor and taste. It is 
soluble in ether, volatile oils. etc.. but insoluble in water and 
alcohol. It melts at 125° to 135° F. (51° to 57° C). 

Petrolatum: Petrolatum. U. S. P.: Petrolatum Album. 
U. S. P. ; Paraffixum Molle, B. P. ; Yaselix\ 

These various soft petrolates have the consistency of an oint- 
ment. They are yellow or white in color, tasteless, and readily 
liquefy a few degrees above body temperature. They are princi- 
pally used as ointment bases. 

Solution of Sodium Silicate ; Liquor Sodii Silicatis ; Liquid 
or Soluble Glass ; Liquid Silex ; Silicate de Soude 
Liquide, F. : Flussiges \Yasserglas. G. 

It is a yellowish, viscid liquid, having a sharp, alkaline taste; 
it is miscible in all proportions with water. 

Acacia: Acacia, U. S. P.: Acacle Gummi, B. P. 

Gum arabic is a gummy exudate obtained from Acacia Senegal 
and other species of acacia, and consists of the potassium, magne- 
sium, and calcium salts of a weakly acid substance known as 
arabin. or arabimic acid. It appears in whitish, translucent, 
roundish tears: it is insoluble in alcohol, but slowly soluble in 
equal parts of water, and is used largely as a vehicle for other 
drugs. 



226 PHARMACO-THERAPEUTICS. 

Mucilage of Acacia; Mucilago Acacisc, U. S. P., B. P. It con- 
tains about 1 part of acacia dissolved in 2 parts of water. Average 
dose, 4 fluidrams (16 Cc). 

Tragacanth ; Tragacantha, U. S. P., B. P. 

A gummy exudation from various species of Astragulus. It 
appears in ribbon-shaped bands or in irregular pieces of a whitish 
color, somewhat translucent. Tragacanth, when treated with 50 
parts of water, swells and gradually forms a cloudy, gelatinous 
jelly. It is chiefly used as a binding agent in pills, troaches, etc. 
Powdered tragacanth is usually the principal component of the 
many powders which are advocated for the purpose of making 
an artificial denture "stick" to the mucous surfaces of the mouth. 
A mucilage, a glycerite, and a compound powder of tragacanth 
are also employed. 

Sassafras Pith; Sassafras Medulla, U. S. P. ; Slippery Elm Bark; 
Ulmus, U. S. P.; Root of Althaea (Marshmallow) ; Althsca, U. S. 
P. ; Linseed or Flaxseed; Linum, U. S. P., B. P. ; Triticum (Couch 
Grass); Triticum, U. S. P.; Starch; Amylum, U. S. P. ; B. P.; 
Licorice Root; Glycyrrhiza, U. S. P., B. P.; Irish Moss or Car- 
ragheen; Chondrus, U. S. P. These various drugs and many of 
their preparations are used as demulcents in general medicine. 

Exsiccated Calcium Sulphate; Calcii Sulphas Exsiccatus, 

U. S. P.; CaS0 4 ; Dried Gypsum; Plaster of Paris; Platre, 

F. ; Gips, G. 

A fine white powder, without odor and taste. When mixed with 
half its own weight of water, it forms a smooth cohesive paste, 
which rapidly hardens. It should be kept in well-closed vessels 
and carefully protected from moisture. A pinch of potassium sul- 
phate, sodium chlorid, or alum dissolved in the water before the 
plaster of Paris is added hastens the setting, and, to some extent, 
prevents expansion. The setting of plaster of Paris is much 
retarded by adding 2 to 4 percent of powdered marshmallow root. 
A cold, saturated solution of sodium hyposulphite will disintegrate 
"set" plaster of Paris within a short time. 

Plasters — adhesive, fatty, or resinous compounds, spread on 



PROTECTIVES, DEMULCENTS, AND EMOLLIENTS. 227 

textile fibers, leather, muslin, etc. — are used to hold the. edges of 
small wounds together or to immobilize parts of the body. Their 
action is purely mechanical. 

Dextrin, gelatin, tragacanth, starch, lycopodium, and many 
inorganic compounds — talc, chalk, zinc oxid, magnesium oxid, 
etc. — are also largely used as protectives, either single or mixed 
to a paste with olive oil, petrolatum, etc. 

Carboltzed Rosin. 

Phenol crystals 4 parts. 

Rosin 4 parts. 

Chloroform 3 parts. 

Cellulo-Aceton (Kowarsky's Paste). 

Celluloid 35-45 parts. 

Aceton 100 parts. 

Chloro-Percha. 

Gutta-percha base plate 10 parts. 

Chloroform a sufficient quantity. 

Sandarac Varnish. 

Sandarac 1 part. 

Rosin, light colored 1 part. 

Alcohol 2 parts. 

Shellac Varnish. 

Shellac 1 part. 

Alcohol 3 parts. 

Glycerinated Gelatin Paste. 

Gelatin 25 parts. 

Water 25 parts. 

Glycerin 50 parts. 

Cover the gelatin with water, let stand for a few hours and 
add the glycerin. Heat in a water bath until solution has taken 
place. This solution must be heated before applied. 



228 PHARM ACO-THERAPEUTICS. 

• Steresol (Antiseptic Wound Varnish). 

Shellac 270 parts. 

Gum benzoin 10 parts. 

Balsam of Tolu 10 parts. 

Phenol 100 parts. 

Oil of cinnamon 6 parts. 

Saccharin 6 parts. 

Alcohol enough to make 1,000 parts. 



IRRITANTS AND COUNTERIRRITANTS. 

The local application of irritants and counterirritants plays an 
important part in the clinical practice of dentistry. Depending 
on their intensity of action, irritants may be classed as rubefa- 
cients, vesicants, and pustulants. Rubefacients (reddening the 
skin) produce only mild symptoms of irritation in the form of 
congestion and redness, while vesicants (drawing blisters) and 
pustulants (forming pustules) are very powerful in their action. 
According to the conception of the older practitioners, irritants 
were employed for the purpose of depleting the "malignant 
humors" from the diseased part into the immediate neighborhood. 
Such irritants were known as derivants, while revulsives were used 
to disseminate these humors into the farther situated parts. In 
many instances irritants are applied to the healthy tissue some- 
what distant from the primary seat of disturbance, with the inten- 
tion of diverting the deep-seated congestion into a new direction, 
or, as our forefathers expressed it, "to leave a way for the escape 
of the humors." Proof for this supposition has never been fur- 
nished. Medicaments applied for these purposes are known as 
counterirritants. If strong irritants are applied to a circumscribed 
area of tissue, an exudation of small globules of serum occurs ; the 
latter soon coalesce and raise the epidermis of the true skin, there- 
by forming a blister. Blistering agents are known as vesicants or 
as epispastics. If the drugs applied as irritants can not pass 
through the horny epidermis, they produce small exanthematous 
abscesses, which may coalesce and form a large ulcer. Drugs used 
for such purposes are referred to as pustulants or suppurants. This 
heroic form of medication is rarely employed at present; it was 



X 



IRRITANTS AND COUNTERIRRITANTS. 229 

quite common with the practitioners of bygone days. Croton oil, 
tartar emetic, veratrin, and mezereum bark are a few examples 
of drugs used as pustulants. 

At present it is generally recognized that the milder irritants 
produce the preliminary stages of inflammation — hyperemia. 
An increased influx and a retarded afflux of blood in the irritated 
tissue is the sequence of the irritation, and not, as it has been 
generally supposed, a diversion of the blood stream. Depending 
on the nature of the irritant, the congestion may be superficial, or 
it may reach to quite a depth. Hyperemia, in the sense of Bier 
(see Artificial Hyperemia), is one of the most important functions 
which nature possesses in overcoming morbid processes. Tissues 
which are richly supplied with blood possess a very pronounced 
restorative power, and there is no doubt that artificial hyperemia 
exercises a distinct beneficial influence on the reparative processes. 
This is partially the reason for wounds in the oral cavity healing 
so much quicker than in other parts of the body. Pain in deep- 
seated structures is often mitigated by applying an irritant. By 
counterirritation of a sensory surface located somewhat distant 
from the primary seat of irritation, we may be able to divert the 
pain to this newly excited focus. Such applications are usually 
employed in the many forms of ill-defined pericemental dis- 
turbances. Some of the substances employed as irritants act by 
reflex action — that is, after their primary action they produce so- 
called reflexes, which have a beneficial influence on pathologic dis- 
turbances. 

It should be remembered that the same irritant produces dif- 
ferent effects on tissues of different resistance. The more delicate 
mucous membrane of the mouth requires naturally less severe irri- 
tation to produce definite results than the thick and horny layers 
of the skin. 

Counterirritation is sometimes referred to as depletion. Deple- 
tives (to empty) are means which were very frequently used in 
former years for the purpose of locally abstracting blood or serum 
from the tissues in general or from the point of disease. Dry and 
wet cupping, scarification, and leeching were the usual methods 
employed for such purposes. Local depletion by physical means 



230 PHARMACO-THERAPEUTICS. 

is rarely practiced at present. General depletion of the system by 
artificially increased perspiration or by abstracting fluids from the 
body through the bowel by salines or hydragogues are referred to 
under Cathartics and Diaphoretics. 

Iodin in aqueous or in alcoholic solution occupies an important 
place among the irritants. It possesses a powerful and penetrat- 
ing action. Alcohol, chloroform, the essential oils, and mustard 
are also favorite irritants, while cantharides are typical representa- 
tives of blistering agents. Ammonia, well diluted, in the form of 
a liniment constitutes an important irritant in popular medica- 
tion. 

Iodin ; Iodum, U. S. P., B. P. ; I ; Iode, F. ; Jod, G. 

Source and Character. — Iodin (from the Greek ioeides, vio- 
let-colored) was discovered by Courtois in 1811, and named iodin 
by Gay-Lussac on account of its violet-colored vapors. Iodin is 
prepared from crude iodin, which is obtained from kelp, but prin- 
cipally from the mother-liquors of Chile saltpeter of South 
America. It forms heavy, bluish-black, friable crystals, having a 
characteristic odor and a sharp and acrid taste. It is soluble in 
5,000 parts of water, 10 parts of alcohol, freely soluble in ether, 
chloroform, and in the solution of the iodids of the alkalies. Its 
alcoholic solution has a reddish-brown color, while, when dissolved 
in chloroform or carbon disulphid, it exhibits a violet tint. It 
volatilizes at ordinary temperature and fuses at about 239° F. 
(115° C). It is incompatible with starch, tannin, vegetable 
colors, etc. 

Average Dose. — 1 / 10 grain (0.005 Gm.). 

Medical Properties. — Antiseptic, caustic, and alterative. 

Therapeutics. — Iodin, in concentrated solution, acts as a caus- 
tic; in diluted solution, applied locally, it produces only irritant 
effects. Iodin has a peculiar action on the vessel walls, as it in- 
creases their penetrability. It produces typical fibrinous inflam- 
mation of the serous membranes. After the destruction of their 
epithelial coat, these serous membranes show a pronounced ten- 
dency to stick together and to heal by first intention. For this 
reason iodin is successfully employed in the treatment of fistulous 



IRRITANTS AND COUNTERIRRITANTS. 231 

tracts, etc. Painted on the skin, iodin quickly penetrates into the 
deeper structures, and produces sensible irritation, thereby in- 

- atly relieving pain which may be present in the deep-seated tis- 
sues. Incidentally it enlarges the walls of the various vessc - pro- 

-motes absorption, and by reflex action produces hyperemia, which 
involves all the tissues within the affected area. The favorable in- 
fluence of this artificially produced hyperemia on the diseased tis- 
sues is more fully discussed under Physical Therapeutics. 
Artificial Hyperemia.) Iodin is very freely employed in an 
alcoholic solution f tincture of iodin). and as the milder acting 
Lugol's solution. In using the tincture of iodin the alcoholic com- 
ponent of the latter must be accredited with a certain share of its 
action. 

To promote the more ready absorption of iodin. various solu- 
tions have been recently introduced. Iodipin, an iodized -e-arne 
oil. containing respectively 10 and 25 percent of iodin. and iothion. 
a glycerinated solution, containing 77 percent of iodin. are 
more important representative- of this group. Both preparations 
are almost colorless and odorless, and are used as substitutes for 
the tincture for external and internal purposes. 

Iodin, per %e or in solution, i.- very destructive to metallic in- 
strument.-. The top of the ground-glass cover office bottle con- 
taining the iodin solution should be coated with a thin lining of 
vaselin as an additional protection. 

Preparations. — 

Trnctur* of Iodin; Tinctura Iodi. U. S. P.. B. P. It contains 
7 percent (2.5 percent. B. P. I of iodin dissolved in alcohol. The 
U. 8. P. tincture contains in addition 5 percent of potassium iodin. 
which increase- its therapeutic effect and stability. 

Compound Solution of Iodin; Liquor Iodi Gompositus, L . >. P. ; 
Lugol's Solution. It contain- 5 percent of iodin dissolved in a 
10-percent aqueous solution of potassium iodid. 

Iodin Liniment; Liquor Iodi Fortis, B. P. It contains about 
14 percent of iodin. 

Therapeutics. — Tincture of iodin is universally employed a- a 
eounteiTrritant in pericemental disturbances. It^ beneficial in- 
fluence is based on three principal functions of iodin — to act as a 



232 PHARMACO-THERAPEUTICS. 

derivant by sensory irritation, to produce artificial hyperemia, and 
to promote absorption. Its antiseptic properties are of less im- 
portance in this connection. If a definite iodin action is desired 
in the mouth, the ordinary tincture is not well suited for this pur- 
pose. Its alcoholic component causes superficial coagulation of 
the delicate mucous membrane, and in reality very little iodin is 
absorbed from this weak solution. If the tincture is repeatedly 
applied at short intervals, the caustic effect of the alcohol destroys 
the mucous lining, and a painful excoriated surface is the result. 
The irritating effect of the alcohol is probably as much responsible 
for the apparent results attributed to the tincture as its iodin com- 
ponent. Liquid iodin preparation for dental purposes should be 
concentrated solutions in water, preferably in the form of Talbot's 
iodin-glycerol. (See page 178.) A colorless tincture of iodin is 
occasionally demanded ; ammonia water added to the tincture will 
quickly destroy its color. If higher concentrated iodin solutions 
are wanted, Carson's or Churchill's iodin paint are serviceable, but 
these compounds should not be used indiscriminately on the 
mucous surfaces of the mouth. 

Tincture of iodin applied to the mucous membranes of the 
mouth is not as harmless a remedy as is presumed by some prac- 
titioners. The routine advice to patients to "paint with iodin" in 
cases of pericemental trouble is wholly unwarranted. From the 
ready absorption of iodin applied to the mucous membrane of the 
mouth for a certain length of time, edema of the glottis and, on 
rare occasions, iodism have resulted. Witzel reports one case which 
ended fatally, and a few others in which the lives of the patrents 
had been endangered by the careless use of this powerful drug. 

If an oily solution of an iodin preparation is needed, aristol oil 
will answer the purpose well. It may be prepared by sterilizing 
2y 4 ounces (70 Gm.) of sesame oil in a flask heated to 302° F. 
(150° C), and adding to the cold oil 2 drams (8 Gm.) of aristol. 
Set aside undisturbed for half an hour. During the next ten 
hours the liquid is repeatedly shaken, and after three or four days 
the solution is siphoned off from the undissolved portion into a 
sterilized bottle. Aristol or its solution should never be heated; 
heat will readily decompose it. 



IRRITANTS AND COUNTERIRRITANTS. 233 

Talbot's Iodo-Glycerol. 

Zinc iodid 15 parts. 

Water 10 parts. 

Iodin 25 parts. 

Glycerin 50 parts. 

Carson's Iodin Paint. 

Iodin . 1 part. 

Alcohol 8 parts. 

Churchill's Iodin Caustic. 

Iodin 1 part. 

Potassium iodid 2 parts. 

Water , . 4 parts. 

The solution should stand in a glass-stoppered bottle for 
several months before it is used. 

Iodin Caustic. 

Iodin 1 part. 

Cresol , 3 parts. 

This caustic is used in fistulous tracts of alveolar abscesses. 

Mustard; Sinapis Alba, U. S. P., B. P. ; Sinapis Nigra, U. S. P., 
B. P. ; Moutarde, F. ; Senfsamen, G. 

Mustard is represented in the two pharmacopeias by the dried 
ripe seeds of the black and white mustard. Both seeds contain 
glucosids; sinigrin is found in the black seed and sinalbin in the 
white seed. When powdered mustard seed is mixed with water, 
decomposition of its glucosid takes place, which results in the 
formation of the volatile oil of mustard. This oil is intensely irri- 
tating to the skin, and when left long enough in contact therewith 
causes blistering. Ground mustard seed is principally employed 
in the form of a plaster or leaf and as a poultice to produce ex- 
ternal irritation. When the leaf is dipped in warm water for a 
minute and placed on the body surface, the volatile oil is pro- 
duced by slow decomposition of the glucosid. The poultice is pre- 
pared by mixing the ground seed with warm water ; it is folded in 
a napkin and then placed on the body surfaces. Mustard, in com- 
bination with powdered capsicum, in the form of bags, as sug- 



234 PHARMACO-THERAPEUTICS. 

gested by Flagg, or, still better, as small dental plasters, are val- 
uable means of producing counterirritation over the roots of 
teeth. These plasters should not be adhesive; they are merely 
placed on the moist gums over the seat of irritation, and held in 
position by a pledget of cotton and the natural pressure of the 




Figure 19. 
Dental Mustard Plasters in Position. 



cheek. A specially prepared dental mustard plaster known as 
sinasin dental plaster deserves to be recommended on account of its 
excellent efficiency. 

Capsicum; Capsicum, U. S. P., B. P.; Cayenne Pepper; Red 
Pepper; Chillies; Poivre de Cayenne, F. ; Spanischer 
Pfeffer, G. 

The dried ripe fruit of Capsicum fast Ig latum. Capsicum con- 
tains some ill-defined, nonvolatile bodies which act as powerful 
irritants. It is principally employed externally in the form of a 
liniment or plaster, and internally as a stomachic. 

Cantharides; Cantharis, U. S. P., B. P.; Spanish Fly; Can- 
tharides, F. ; Spanische Fliege, G. 

It is the dried beetle, Cantharis veslcatoria. The beetles con- 
tain cantharidin, a derivative of benzol, which is a powerful 
vesicant. In the form of a cerate, plaster, or collodion, it is largely 
used as a blistering agent. In the mouth the cantharidal collodion 
is occasionally employed, but there is rarely need for the use of 
this powerful remedy in the mouth. 

Ammonia Water ; Aqua Ammonle, U. S. P. ; Liquor Am- 
monle, B. P. ; Eau d'Ammoniaque, F. ; Salmiakgeist, G. 

It is an aqueous solution of ammonia (NH 3 ), containing 10 
percent by weight of gaseous ammonia. 



IRRITANTS AND COUNTERIRRITANTS. 235 

Stronger Water of Ammonia; Aqua Ammonias Fortier, U. S. 
P.; Liquor Ammoniss Fortier, B. P. An aqueous solution of am- 
monia, containing 28 percent (32.5 percent, B. P.) by weight of 
gaseous ammonia. 

Ammonia Liniment; Linimentum Ammonite, U. S. P., B. P. 
A volatile liniment, containing 3.5 percent (2.5 percent, B. P.) of 
ammonia. 

The various ammonia solutions are principally employed in di- 
luted form as liniments in popular medicines; they act as rube- 
facients, and are used in sprains, bruises, etc. As skin irritants 
and vesicants they are rarely employed at present. In the form 
of smelling salts, ammonia is used by inhaling its gas as a reflex 
stimulant in fainting, etc. 

Alcohol, per se, or as a solvent of essential oils and other vola- 
tile substances — spirit of camphor, chloroform, juniper, lavender, 
peppermint, spearmint, etc. — is widely used as an external irritat- 
ing lotion. The alcoholic solutions of volatile substances com- 
bined with anodynes are often applied to the face as antineuralgics. 

Hoff's Dental Liniment. 

Ifc. Chloroform. 

Ether. aa A3 ij (8 Cc.) 

Menthol. 3 j (4.0 Gm.) 

Spirit, camphor. A3 j (4 Cc.) 

Spirit, rosmarin. A3 ij (8 Cc.) 

Aquae ammoniae A3 v (20 Cc.) 

Tinct. capsic. A, 5 j (30 Cc.) 

M. f. liniment. 

Sig. : For external use only. With a wad of cotton the 
liniment is applied to the painful surfaces of the cheek in 
neuralgia. Care should be taken not to get it into the eyes. 

English Smelling Salts. 

Ammonium carbonate 80 parts. 

Ammonium chlorid 20 parts. 

Oil of lavender 5 parts. 

Oil of lemon 2 parts. 

Oil of bergamot 1 part. 

Alcohol 5 parts. 

Glycerin 3 parts. 

The salts are coarsely powdered and perfumed with the alco- 
holic solution of the oils; lastly add the glycerin. Keep in 
well-stoppered bottles. 



236 PHARMACO-THERAPEUTICS. 

ANTACIDS. 

Antacids are agents which neutralize acids by their alkaline or 
basic properties ; their action is always of a chemic nature. In gen- 
eral medicine, antacids are usually employed to reduce the acidity 
of the secretions of the stomach and, sometimes, of the urine, and 
to increase the reduced alkalinity of the blood. In dentistry they 
are used to locally neutralize hyperacidity of oral secretions. Be- 
fore applying an antacid the acidity of the oral secretions should 
be positively established. To test the secretions, the mouth must 
be repeatedly rinsed with a warm physiologic salt solution, and 
a piece of blue and red litmus paper is alternately applied about 
the upper buccal regions of the molars and under the tip of the 
tongue. Litmus paper as an indicator of acidity in the mouth is 
quite sufficient, but the test must be repeated three or four times at 
short intervals and on different days, and preferably at different 
periods of the day. The relation of the saliva to dental caries 
is referred to under Preparations for the Mouth and Teeth. 

The action of the chemicals used in the mouth for the purpose 
of neutralizing the oral secretions is only of a temporary char- 
acter. The insoluble carbonates of calcium and magnesium and 
the hydrate of the latter are preferred for such work. The readily 
soluble sodium bicarbonate is only of temporary assistance. Caus- 
tic alkalies must be carefully avoided in the mouth. 

If antacids are indicated, the best time for their application is 
in the evening before retiring. After the mouth is thoroughly 
rinsed the teeth should be evenly coated with the hydrate of mag- 
nesium (milk of magnesia), or a thin mixture of precipitated cal- 
cium carbonate and water, and left in place over night. All traces 
of the coating should be removed by thorough rinsing the follow- 
ing morning. 

Precipitated Calcium Carbonate; Calcii Carbonas Precipi- 
tatus, U. S. P., B. P.; CaC0 3 ; Precipitated Chalk; Calcium 
Carbonate; Carbonate de Chaux, F. ; Pracipitirter Koh- 
lensaurer Kalk, G. 

It is a fine white, impalpable powder, without odor and taste, 



ANTACIDS. 237 

and permanently in the air. It is nearly insoluble in water and 
insoluble in alcohol. In diluted acetic, hydrochloric, or nitric- 
acid it is completely soluble, with effervescence. 

Prepared Chalk; Creta Pr^eparata, U. S. P., B. P. ; CaCO , ; 
Whiting; Craie Lavee, F. ; Schlemmkreide, G. 

It is a native calcium carbonate, freed from most of its im- 
purities by elutriation. It is a white or grayish fine powder in the 
form of conical drops; odorless and tasteless, and permanent in 
the air. Chemically it behaves like the precipitated calcium car- 
bonate. Calcium carbonate forms the base of many of the solid 
and semi-solid commercial tooth preparations. Only the very best 
precipitated calcium carbonate, and not prepared chalk, should be 
utilized for such purposes to prevent mechanical abrasion of the 
enamel. (See Preparations for the Mouth and Teeth.) 

Solution of Calcium Hydroxid; Liquor Calcis, U. S. P., 
B. P. ; Lime Water ; Eau de Chaux, F. ; Kalkwasser, G. 

It is a saturated solution of slacked lime in water, containing 
about 0.15 percent of calcium hydroxid. It is a clear, colorless 
liquid, without odor and having an alkaline, feebly caustic taste. 

Average Dose. — 4 nuidrams (10 Cc). 

Magnesium Carbonate; Magxesii Carboxas, U. S. P. ; (MgCo a ) 4 
Mg(OH) 2 +5H 2 0; Magnesii Carbonas Levi, B. P.; Mag- 
nesii Carbonas Ponderosa, B. P.; ?>(Mg€0 3 ),Mg(OH)o+ 
4H 2 0; Magnesie Blanche, F. ; Kohlexsaure Magnesia, G. 

Magnesia; Magnesii Oxidum, U. S. P.; Magnesii Oxidum Pon- 
derosum, L T . S. P.; Magnesia Levis, B. P.; MgO ; Heavy Mag- 
nesium O.vidi; Magnesie Calcinee, F. ; Gebrannte Magnesia, G. 
These magnesium compounds form white masses or amorphous 
powders, with an earthy, but not saline, taste. They are prac- 
tically insoluble in water and alcohol, but readily soluble in acids. 
with effervescence. 

Average Dose. — 30 grains (2 Gm.). 

Milk of Magnesia; Maglactis; Lait de Magnesie, F. ; Magne- 
siamilch, G. It is a hydrate of magnesia, and form- a semi- 



238 PHARMACO-THERAPEUTICS. 

gelatinous liquid, containing freshly precipitated magnesium oxi- 
hydrate prepared by the interaction of magnesium sulphate and 
ammonia water; the precipitate is collected and washed with dis- 
tilled water until the washing ceases to give a reaction for sul- 
phates. Hydrated magnesia mixtures containing gum arabic, 
tragacanth, or other gummy substances should not be used. 

Sodium Bicarbonate; Sodii Bicarbonas, U. S. P., B. P.; 
XaHC0 3 ; Bicarbonate de Soude, F. ; Doppeltkohlensaures 
Natron, G. 

It is a white, odorless powder, having a cooling, mildly alkaline 
taste. It is soluble in about 12 parts of water at ordinary tem- 
perature ; hot water gradually decomposes its solution. It is in- 
soluble in alcohol. With acids its solutions effervesce strongly. 

Average Dose. — 15 grains (1 Gm.). 

BLEACHING AGENTS. 

Dental bleaching agents are chemicals used for the purpose of 
removing pigmentations from tooth structure. By bleaching we 
understand the destruction or changing of a color compound into 
a colorless material; it is caused by the chemic reaction which 
occurs between the bleaching agent and the color compound. 

Discoloration of a tooth is usually the result of the death of its 
pulp, although metallic stains and pigmentations from medicines 
or other materials used in the tooth may also be causative factors. 
Superficial stains of the enamel or dentin, which are removed by 
simple mechanical means, are not classed as discolorations. 

Causes of Discoloration. 

The causes of discoloration may be due to organic or inorganic 
substances. The organic pigments may arise from the changes 
which occur in a dead pulp or from medicinal substances. 
Whether the pulp dies from mechanical, chemic (including bac- 
terial), or thermal causes has no bearing on the formation of the 
pigment. The inorganic pigments are the result of chemic 



BLEACHING AGENTS. 239 

changes which occur through lh<' formation of soluble .salts of the 
various metals used in or about the teeth-— fillings, posts, retention 
appliances, He The color range of pigmentation depends on the 
nature of the cause: a dying pulp may produce all shades between 
a pinkish hue, yellow, brown, bluish-gray, and black, while me- 
tallic stains usually assume the color of their respective sails. The 
decomposition of the hemoglobin of a dying pulp apparently 
forms certain sulphur compounds — sulphur sulphid, etc. — which 
arc hold principally responsible for the discoloration, although 
(his supposition is as yet not fully proved. The theoretical con- 
sideration of these changes lias been interestingly discussed by 
Kiik' and Buckley, 2 and the reader is referred to their com- 
munications for further information. The pinkish pigmentation 
is the result of a sudden effusion of blood into the dentinal tubules; 
it has been observed after the application of arsenic on the ex- 
posed pulp, iu typhoid fever, cholera, and other acute exanthema, 

and iu persons whose death is caused by hanging or drowning. 8 
If it is due to exanthematous diseases, without death of the pulp, 
the normal color of the tooth usually returns with the determina- 
tion of the disease. Of the medicinal substances, the oil of cassia. 
which is freely used by many practitioners in the treatment of 
putrescent root canals, is the chief organic coloring agent met in 
discolored teeth. Oil of cassia contains furfural, a colorless pyro- 
niucic aldehyd, which readily turns brown on exposure to air and 
light. (See Oil of Cassia.) It produces a light-brown color of the 
tooth substance. So far as known, the other essential oils which 
are usually employed in the treatment of the teeth do not con- 
tain furfural or other pigmenl agents. Arsenical pastes as pur- 
chased at dental depots arc 1 sometimes colored with organic pig- 
ments. The author has seen a tooth turning bright-blue within 
twenty-four hours from the application of an arsenical paste con- 
taining methylen blue. 

.Metallic stains in teeth vary materially in their color; the latter 
depends on the metal from which the soluble salt is derived. The 



1 Kirk: American Text Book of Operative Dentistry, 1905, p. 535. 

2 Buckley: Johnson's Text Book of Operative Dentistry, 1908, p. 367. 

3 Bell: The Anatomy, Physiology, and Diseases of the Teeth, 1837, p. 12. 



240 PHARMACO-THERAPEUTICS. 

gold stain may result from the injudicious use of gold instru- 
ments in the process of bleaching, from gold left in a tooth prior 
to bleaching, or from gold coming in contact with nitrohydro- 
chloric acid — as when the acid is employed for the purpose of en- 
larging a root canal. The stain produced is of a pinkish hue, and 
is the result of the chlorin action on the gold. In course of time 
the pink color changes to violet or purple, and finally becomes 
black. Iron stains are produced by steel instruments when used 
in connection with mineral acids, iodin, or chlorin; at first they 
assume a yellowish tint, which later turns brown or black. Nickel 
and copper stains arise from the use of these metals or their alloys 
in or about the teeth — German silver (also known as platinoid, 
Victoria metal, etc.), copper amalgam, brass, etc. The copper 
stain is the well-known bluish-black color (copper amalgam stain) 
which we find so frequently in Europeans who have their teeth 
filled with this alloy, and the nickel stain is a grass-green color, 
which finally becomes black. Silver stains are jet black ; they are 
principally the result of the too free application of silver nitrate 
(and of silver lactate and citrate) in substance or in solution. The 
typical discoloration of silver salts on the teeth is known as dental 
argyria. (See Silver Nitrate.) Mercury stains are principally 
caused by the change of mercuric chlorid into a sulphid; the 
shades range from a slate-blue to a distinct black. (See Mercuric 
Chlorid.) Mercuric chlorid was formerly freely used in the 
treatment of teeth; on account of the resultant discoloration it has 
been abandoned for such purposes. Manganese stains result from 
the decomposition of manganese salts, especially potassium per- 
manganate, which in former years was frequently employed as an 
antiseptic in the treatment of putrescent root canals ; the stains are 
of a deep-brown color. 

Superficial stains found on teeth — the discolorations resulting 
from the use of tobacco, the eating of various fruits (black cher- 
ries, blueberries, etc. ) , and the green discoloration on the teeth of 
children (growth of various molds and fungi) — are readily re- 
moved mechanically. This also holds good for the superficial 
metal stains found on the teeth of certain metal workers, espe- 
cially brass polishers, etc. The habitual chewing of the betel nut, 



BLEACHING AGENTS. 241 

Areca catechu, by the natives of India, Africa, and other oriental 
countries produces a permanent black stain on their teeth, but in- 
cidentally it exercises a marked beneficial effect on the gum tis- 
sues by the solution of certain astringents and antiseptics present 
in the nuts. Betel nut chewers are said to be free from pyorrhea, 

Preparing the Tooth for Bleaching. 

Before starting the bleaching process, a careful diagnosis should 
be made to possibly ascertain the cause of the pigmentation. If 
the latter can be definitely traced, it is a simple matter to select 
the proper bleaching agents. The close observation of a few gen- 
eral details governing all bleaching processes is essential to insure 
ultimate success. The tooth under consideration, prior to the 
bleaching process, must receive proper treatment as regards its 
pathologic condition. The septic contents of the pulp chamber 
and the canal have to be removed, and any existing disturbances 
about the pericementum must be promptly relieved. The upper 
two-thirds of its aseptic canal are now permanently closed with 
cement, and the tooth is then ready for the bleaching process. 
The rubber dam must always be applied over the tooth under 
treatment, including, according to circumstances, an additional 
tooth on either side. It should be sufficiently large to completely 
cover the mouth and nose, so as to prevent the inhalation of aris- 
ing gases — chlorin, etc. The dam is carefully tucked under the 
free margin of the gum, and, to prevent seeping of the bleaching 
agent under the dam, a waxed silk ligature is passed twice about 
the tooth and tied with a few knots, lingually and labially. As an 
additional precaution, the ligature and the dam in the immediate 
vicinity are painted with sandarac varnish or thin chloro-percha. 
It is understood that all carious tissue, metallic fillings, etc., have 
been removed, and that the root canal up to the cement filling is 
sufficiently enlarged to present a clear view of the interior of the 
tooth. A thorough swabbing with alcohol, followed by a copiou> 
bath with hot distilled water containing 10 percent of borax, will 
complete the preliminary preparations. 

The instruments to be used in applying the bleaching agents 



242 PHARMACO-THERAPEUTICS. 

should be made of vulcanite, bone, ivory, or wood. All metallic 
instruments should be carefully avoided, as they are easily af- 
fected by the chemicals, especially chlorin, which readily forms 
soluble metallic salts, and the latter may give rise to permanent 
stains of the tooth substance. Instruments made of zinc or 
aluminum mav be used ; their chlorids are colorless salts. 



Bleaching Processes. 

Two methods are at present in vogue for the destruction of 
organic pigments in teeth, and both methods depend on the pres- 
ence of oxygen. The oxidation method depends on the utiliza- 
tion of free oxygen as liberated from oxygen compounds, either 
directly or indirectly, and the reduction method depends on the 
abstraction of oxygen from the color compound. Oxygen, in its 
nascent state, is readily obtained by the decomposition of certain 
compounds which contain it, loosely bound, to a greater or lesser 
extent. The principal compounds are sodium dioxid, 25 percent 
ethereal solution of hydrogen dioxid (pyrozon), 30 percent 
aqueous solution of hydrogen dioxid (perhydrol), barrium dioxid, 
alphozon, acetozon, ammonium chlorid in combination with the 
official solution of hydrogen dioxid, etc. Indirectly, oxygen may 
be liberated by the action of free chlorin on moisture ; in the pres- 
ence of the latter, chlorin readily unites with the hydrogen of the 
hydrogen oxid (water) molecule, forming hydrochloric acid and 
setting free nascent oxygen. The chemicals usually employed for 
such purposes are chlorinated lime or its solutions — Labarraque's 
solution, etc. (see page 106) — acted upon by a weak acid, as 
acetic, tartaric, or oxalic acid. 

The reduction method is based on the liberation of oxygen from 
a color compound by the action of a powerful reducing agent; 
sulphurous acid is universally employed for practical purposes. 
"Its activity is due to its affinity for oxygen, and it bleaches by 
seizing upon and combining with that element of the color mole- 
cule, thus destroying its identity, and consequentlv its color." 
(Kirk.) 

The universal method employed at present for the bleaching of 



BLEACHING AGENTS. 243 

teeth consists in the utilization of free oxygen. (See Solutions 
Which Evolve Nascent Oxygen.) Sodium dioxid, introduced by 
Kirk in 1893, is readily available for this purpose. It may be 
used in dry form or as a saturated solution. The dry powder or 
a thick paste, made by mixing it with chloroform, as Buckley 
suggests, is packed into the tooth with suitable vulcanite or ivory 
instruments, a drop of distilled water is placed on the powder, and 
atomic oxygen is at once set free according to the equation : 

NaA+H 2 0==2NaOH+0. 

Nascent oxygen is a powerful oxidizer, and readily attacks any 
organic material with which it comes in contact. If the pigmenta- 
tion of the tooth is derived from organic sources, the destruction 
of the color is soon manifested by the bleached appearance of the 
tooth. The latter assumes a creamy color as a result of the freshly 
prepared sodium hydroxid, which penetrates deeply into the 
tubules. To remove this yellowish tint and to enhance the libera- 
tion of atomic oxygen, a weak acid, usually sulphuric or hydro- 
chloric acid in 5 to 10-percent solution, is now applied. With the 
latter acid the following reaction occurs: 

Na 2 2 +2HCl=2NaCl + H 2 2 - 

The inert sodium chlorid formed as a byproduct is of no 
further consequence. If the bleaching is not satisfactorily accom- 
plished after the first two trials, a second attempt should be made 
within the next few days. After the bleaching the tooth should 
be thoroughly washed with hot distilled water, and filled with 
gutta-percha until the next visit of the patient. It is good prac- 
tice to bleach the discolored tooth a few shades lighter than its 
mate, as a bleached tooth usually loses the higher shades in a little 
while. After the operation is completed the dry cavity is var- 
nished with a colorless cavity varnish, filled with a lining of ce- 
ment which in color corresponds to the shade of the tooth, and a 
permanent filling may then be inserted. 

If a saturated solution of sodium dioxid (see page 117) is used 
instead of the powder, the procedure is very much the same. The 
liquid is best carried to the tooth on a wooden toothpick wrapped 



244 PHARMACO-THERAPEUTICS. 

with asbestos wool; the latter is previously heated in a flame. 
Kirk states that "the sodium dioxid method removes more com- 
pletely than any other the tubular contents, and the result is 
unique from the fact that not alone is the tooth restored to the 
normal color, but to normal translucency ; the opaque white ef- 
fect resulting from other methods is due to the bleached organic 
debris remaining in the tubules, but by the solvent action of the 
strong caustic alkali this is removed. " 

The application of concentrated solutions of hydrogen dioxid 
for bleaching purposes is much the same as that employed for 
sodium dioxid or its solutions. Perhydrol, being an aqueous 
neutral solution containing about 100 percent of available hydro- 
gen dioxid by volume, is especially suitable for the purpose. The 
solution is applied as stated, and by the evaporation of the water 
with the hot-air blast or a heated ball burnisher the bleaching 
process is much facilitated. Good results are usually obtained with 
this method. 

The bleaching of teeth by cataphoresis is only of historic in- 
terest at present. 

In bleaching teeth by the chlorin method, or the Truman 
method, as it is sometimes referred to in honor of its discoverer, 
the procedure is as follows : The general preparation of the tooth 
is the same as outlined above. A high-grade preparation of 
chlorinated lime, obtained in an original glass container and 
manufactured by a reliable chemical house, is of prime impor- 
tance to obtain good results. The necessary quantity of the powder • 
is mixed with distilled water to a stiff paste and placed into the 
tooth. As much moisture as possible is removed with pellets of 
cotton, and a weak acid, preferably . diluted acetic acid, is now ap- 
plied, and the cavity is immediately sealed with temporary stop- 
ping. The treatment is repeated in one or two days, or as often 
as necessary until the normal color of the tooth is restored. 

Metallic stains require specific treatment. 1 Gold, iron, copper, 
and nickel stains are best removed by the chlorin method; silver 
nitrate stains are removed by chlorin, or by first saturating the 
tooth with tincture of iodin and then applying a saturated solu- 

1 Kirk: Loc. cit. 



PREPARATIONS FOR THE MOUTH AND TEETH. 245 

tion of sodium hyposulphite. Mercurial stains are removed by an 
ammoniacal solution of hydrogen dioxid, followed by a saturated 
solution of potassium iodid. The stains of manganese yield 
readily to a concentrated solution of hydrogen dioxid (perhydrol) 
saturated with oxalic acid. 



PREPARATIONS FOR THE MOUTH AND 

TEETH. 

The remedies intended for the mouth and teeth may be con- 
veniently divided into those prescribed for specific diseased con- 
ditions and those used as hygienic cosmetics for daily use. The 
hygienic care of the mouth intends principally to keep the mouth 
and teeth in a healthy condition. This object may be accom- 
plished by the proper employment of mechanical and chemic 
methods. The mechanical cleansing of the mouth and teeth by 
means of the brush, toothpick, floss silk, powder, paste, etc., will 
always be the fundamental principle of oral hygiene. Mechan- 
ical cleansing alone is not, however, sufficient for such purposes, 
and the additional use of antiseptic solutions is essential to obtain 
the best results. Food remnants and slimy adhesions between and 
on the teeth, which form a favorable pabulum for the micro-organ- 
isms, together with a large number of the adherent bacteria, are 
removed by mechanical cleansing. Mouth washes are employed 
for the sole purpose of keeping the oral tissues in a healthy condi- 
tion. They must favor the recovery of inflamed mucous mem- 
brane, which is so frequently present in a mild degree, and they 
must be sufficiently antiseptic to inhibit the growth of fisson fungi 
and pathogenic bacteria. A good antiseptic mouth wash should, 
according to Rose, 1 possess the following properties: 

1. Absolute indifference in regard to (a) the mucous mem- 
brane of the mouth — noncaustic, (b) the teeth — nondecalcifying, 
(c) the organism as a whole— nonpoisonous. 

2. Sufficient antiseptic action. 

3. Good taste and odor. 

These various properties are naturally rarely found in combina- 



T Rose: Instructions in the Care of the Teeth and the Mouth, 1900. 



246 PHARMACO THERAPEUTICS. 

tion, and yet each one is of importance. A mouth wash which 
has a disgusting taste is as ineffective as one which has no germi- 
cidal action. The great mass of the public will never be induced 
to practice oral hygiene that involves an ill-tasting mouth wash. 
Absolute safety is of the greatest importance. The value of oral 
antisepsis is so great that we are not justified in assuming the 
slightest risk. In general too little attention has been paid in 
the past to the deleterious influence of mouth washes on the 
mucous membrane. A healthy mucous membrane is the founda- 
tion of a successful hygiene of the mouth. The mouth of a 
healthy person is fairly well protected against the continuous on- 
slaughts of the omnipresent bacteria through an unusually large 
blood supply of the oral tissues, a higher resistance of its epithelial 
lining, and a continuous flow of saliva. The much discussed 
bactericidal action of the latter, which is claimed to be due to the 
presence of small and very variable quantities of potassium sulpho- 
cyanid, has been scientifically disproved by the classic researches 
of Miller 1 and Bruylant. 2 Potassium sulphocyanid (rhodanid) 
is constantly present in the saliva and in the urine of man, it is 
occasionally found in the saliva of the dog, but so far has not 
been obtained from the horse, cattle, goat, sheep, or pig. The 
quantity of potassium sulphocyanid does not depend on age, sex, 
the healthy or diseased conditions of the teeth, etc. In smokers 
frequently twice or three times as much is present as in non- 
smokers. In the normal mouth pathogenic micro-organisms are 
usually less virulent, and they are the subordinates of the sapro- 
phydic germs. Fliigge 3 has shown that the pathogenic bacteria 
will become extremely active if the individual is afflicted with a 
slight local disturbance — as a simple catarrh of the throat. Claer- 
mont has expressed similar views, and after a careful study of 
the fluids of the mouth he asserts that one is not justified in 
stating that saliva possesses a definite bactericidal action. It seems, 
however, that the parotid saliva of man and of some animals (espe- 
cially the goat) exercises an inhibitory function on certain micro- 
organisms — the staphylococci and the streptococci. An interest- 



1 Miller: Deutsche Monatsschrif t fiir Zahnheilkunde, 1903. 

2 Bruylant: Jahresbericht der Tierchemie, Vol. XVIII. 

3 Fliigge: Berichte des Chemischen Institutes, Breslau, 1900. 



PREPARATIONS FOR THE MOUTH AND TEETH. 247 

ing observation is made by Hodges, who ascertained that steril- 
ized saliva furnishes a suitable pabulum for the luxuriant growth 
of bacteria, while the normal saliva exercises an inhibitory action 
on the vitality of the latter. Reasoning on these factors, one is 
forced to admit that the normal oral secretions possess at least the 
power of inhibiting to some extent the virulence of pathogenic 
germs, provided that all the oral tissues are kept in a healthy 
condition. 

In a recent communication Michel 1 published his observations 
concerning the relation of potassium sulphocyanid to dental caries. 
His writings are based on observations made within the last ten 
years in the Wiirzburg Dental Clinic, and he arrives at the follow- 
ing conclusions: Sulphocyanid present in the saliva inhibits the 
virulence of the oral bacteria, and consequently retards the caus- 
ative factors of dental caries. If we are able to furnish the miss- 
ing sulphocyanid by internal administrations to those patients 
who are subject to a tendency to dental caries, the predisposition 
to the latter disease will be diminished. The temporary adminis- 
tration of potassium sulphocyanid materially increases the pres- 
ence of this salt in the saliva, and apparently causes a stimulation 
of those centers which normally control the production of this 
chemical in the body. The soundness of this hypothesis can be 
proved only by thousands of observations, which should be carried 
on simultaneously by a large number of investigators. 

From these conclusions drawn bv Michel, and from similar re- 
ports made by a number of other observers, the cautious adminis- 
tration of potassium sulphocyanid is probably indicated in cases 
where an absence of the salt is proved by an analysis of the saliva 
and where a predisposition to caries is held responsible for the 
missing sulphocyanid. The salt may be administered in 3-grain 
(0.2 Gra.) doses four times daily in solution or powder. A 
preparation which is said to contain a sulphocyanid salt in a 
ready absorbable form, known as cariesan, has been recently placed 
on the market. It is understood that carefully kept records in 
regard to hygienic conditions of the oral cavity, analysis of the 



1 Michel: Die Mundfliissigkeit und Ihr Einfluss auf die in der Mundhohle Ablaufenden Patho- 
logischen Vorgange, 1909. 



248 PHARMACO-THERAPEUTICS. 

saliva, etc., are absolutely essential if correct deductions are to be 
drawn from these clinical observations. 

In constructing a formula for a mouth preparation the follow- 
ing drugs must be avoided: Alum, charcoal, formaldehyd solu- 
tion, iron salts, mineral acids (with the exception of boric acid), 
mercury salts, potassium salts, salicylic acid and salol, beet and 
cane sugars, and easily fermentable substances. 

A few of the more widely advertised preparations which are 
distinctly dangerous to the oral tissues when employed for daily 
use, and which are apparently universally recommended by the 
profession, deserve special notice. Little antiseptic power and 
bad taste are the lesser evils of most of these preparations. The 
conception that mouth washes, tooth powders, and pastes which, 
in general, are nonpoisonous and neutral in reaction are indiffer- 
ent to the oral tissues is erroneous. 

Recently a tooth paste containing 50 percent of potassium 
chlorate has been widely advertised as an oral antiseptic. The 
pharmacologic action of potassium chlorate is erroneously at- 
tributed to nascent oxygen, which, it is claimed, is set free after 
it is absorbed by the tissues. Potassium chlorate has no more 
value in the oral cavity than an equal amount of sodium chlorid, 
and, besides, is a specific blood poison. After its absorption into 
the blood it changes oxyhemoglobin into methemoglobin and 
produces a multiple destruction of red blood cells. Clinical ob- 
servation has further demonstrated the fact that the continuous 
use of this paste, aside from its disagreeable salty taste, produces 
inflamed and easily bleeding gum margins. The poisonous 
nature of potassium chlorate is manifested in a number of deaths 
which have resulted from its absorption when applied in solution 
or in substance on the oral mucous membranes. 

Within recent years certain substances which furnish free oxy- 
gen in the mouth are highly recommended as additions to tooth 
powders — as dioxids of calcium, magnesium, strontium, etc., and 
sodium perborate. Calcium dioxid should not be used as a 
component of a tooth powder; in the presence of the acids of 
fermentation it is split up into nascent oxygen and calcium oxid 
(milk of lime). The latter is strongly irritating to the soft tis- 



PREPARATIONS FOR THE MOUTH AND TEETH. 249 

sues, and the continuous use of a tooth powder which contains an 

appreciable percentage of calcium dioxid will cause more or less 
pronounced gingivitis. The fallacy of the "oxygen" theorist who 
bases his deduction on the supposition that the end justifies the 
means is clearly illustrated by the following production of a 
speculative mind: 

Very recently a so-called "hydrozon" tooth paste has been in- 
troduced by a German manufacturer of pharmaceutic prepara- 
tions. It is stated that this paste produces nascent oxygen when 
it is brought in contact with the fluids of the mouth. According 
to the patent claims this paste is composed of an ordinary starch 
paste holding hydrogen dioxid solution in suspension. Small 
quantities of plaster of Paris are added to this mixture to bind 
the water of the hydrogen dioxid solution in the form of water of 
crystallization. The presence of starch is readily revealed by the 
iodin test, while, as may be expected, the acid potassium chromate 
test does not show a trace of hydrogen dioxid in a sample pur- 
chased in the open market. Starch — an easily fermentable carbo- 
hydrate — added to tooth paste means to whip the Devil with 
Beelzebub. The hydrozon tooth paste is another sample of how 
readily the profession may be hoodwinked by the ludicrous state- 
ments of so-called reliable pharmaceutic manufacturing concerns. 
The latest additions to oral specialties is a tooth paste contain- 
ing hexamethylenamin and one which contains isoform (para- 
iodanisol) . Isoform is an almost odorless substitute for iodo- 
form, while hexamethylenamin is supposed to be decomposed in 
the mouth by the action of the alkaline saliva into ammonia and 
formaldehyd. 

Salicylic acid and its component, salol. were at one time, and 
are still to some extent, used in mouth washes. Chemicallv. salol 
is phenyl salicylate : it is split up by the secretions of the mouth 
and the intestines into salicylic acid and phenol. Salicylic acid 
is strongly keratolytic in its action, and decalcifies tooth struc- 
ture. It has been further observed that a highly flavored concen- 
trated alcoholic solution of salol. which is the prototype of a 
widely advertised proprietary article, is prone to produce a peculiar 
eczematous eruption about the external mouth, and especially at 



250 PHARMACO-THERAPEUTICS. 

the corners. This disease is known as mouth wash eczema. 
Simple prohibition of the salol solution usually brings about a 
speedy recovery. The recent craze for adding formaldehyd to 
things in general which sail under the elucidative appellation of 
oral antiseptics has done much harm ; its addition to mouth washes 
in appreciable quantities is distinctly dangerous. All alkalies, in- 
cluding soap, but with the exception of the carbonates of calcium 
and magnesium and of sodium bicarbonate, should be used very 
sparingly in the mouth, while all mineral acids, with the excep- 
tion of boric acid, must be positively forbidden in mouth and tooth 
preparations. 

Alkaline saliva and, as a consequence, alkaline mouth washes 
have been for some time the shibboleth of those interested in oral 
hygiene. Illogic deductions are based on erroneous conceptions 
of the physiology and bacteriology of the mouth. The temporary 
alkalinity of the mouth does not alter the reaction of the con- 
tinuously outpouring saliva. In general, micro-organisms require 
a neutral or a slightly alkaline pabulum for their existence, and 
the average mixed saliva, which usually shows an alkaline reac- 
tion, would be, biologically speaking, a suitable medium for the 
ready growth of most of the pathogenic germs. To check the 
virulence of the acid producing germs in the mouth, the real fac- 
tors of dental caries, with alkaline washes is, for teleological rea- 
sons, a contradiction in itself. It is not the temporary neutraliza- 
tion of these acids which we seek in combating dental caries, but 
it is the inhibition and, if possible, the destruction of the acid 
producing micro-organisms which we anticipate. As an analogy, 
we may be permitted to cite that a city which is scourged with 
an epidemic of typhoid fever as a result of an impure water 
supply does not merely depend on the medical care of the typhoid 
patients for the eradication of the epidemic, but on the removal 
of the cause — the polluted water supply. 

Again, Rose's statement, "the importance of oral antisepsis is 
so great that we are not justified in assuming the slightest risk," 
can not be emphasized too strongly in view of the fact that num- 
berless mouth washes of questionable character are continuously 
forced on the market. Unless the correct composition of a pro- 



PREPARATIONS FOR THE MOUTH AND TEETH. 251 

prietary mouth wash or ether tooth preparations is known, it 
should not be prescribed. 

The search for so-called tartar solvents as an addition to tooth 
preparations — substances which prevent or dissolve calcareous de- 
posits about the teeth — has occupied the mind of the dental 
hygienist for some time past. The chemic nature of the oral 
calculus indicates that the logic solvent should be an acid or acid 
salt. For plausible reasons such acids can not be utilized in the 
mouth. It is known, however, that certain alkalies — the salines — 
prevent a ready formation of calculus, and they help to remove 
fresh deposits when brought in intimate contact therewith. Just 
how much of this destruction or removal should be attributed to 
the mechanical scrubbing of the brush, and how much to the 
abrasive action of the ingredients of the tooth powder or paste, 
has never been determined. Nevertheless the salts of certain 
mineral springs, especially those of Carlsbad, are used in concen- 
trated form for such purposes, and apparently with some success. 
The Carlsbad salts may be incorporated into a paste with calcium 
carbonate and other abrasives; its only drawback is its very dis- 
agreeable salty taste. Tooth pastes containing about 25 percent 
Carlsbad salt may now be obtained in the market. 

A true tartar solvent, which, however, has no direct bearing on 
the subject of "Preparations for the Mouth and Teeth," has been 
recently introduced by Head. 1 It is a solution of hydrogen am- 
monium fluorid (ammonium bifluorid). According to Head it 
may be prepared as follows: Neutralize hydrofluoric acid with 
ammonium carbonate and filter. Carefully evaporate the solu- 
tion at a temperature of 90° to 105° F. (32° to 41° C.) to one-half 
its bulk, fill up to its original volume with the acid, and once 
more evaporate to one-half its bulk. The resulting liquor is the 
solution of ammonium bifluorid, ready for therapeutic use. The 
preparation of this solution should be left to an experienced chem- 
ist, as hydrofluoric acid is an extremely dangerous agent to handle. 
The ready prepared solution may now be obtained from dental 
depots under the name of "tartar solvent." The ammonium bi- 
fluorid solution is used for the disintegration of the calcareous 



1 Head: Items of Interest, 1909, p. 174 



252 PHARMACO-THERAPEUTICS. 

deposits on teeth, and its application is referred to under Uric 
Acid Solvents. 

Authorities differ widely as regards the ideal antiseptic for the 
oral cavity. An absolutely indifferent, and yet mild, antiseptic 
effect is obtained from a physiologic salt solution heated to body 
temperature. To sterilize the oral cavity completely, even for only 
a short time, is quite impossible. If powerful antiseptics are 
used to accomplish this purpose, the results are distinctly danger- 
ous to the local tissues and to the organism as a whole. Clinical 
experience, coupled with scientific research, points to the fact 
that a solution of alcohol, hydrogen dioxid, resorcinol, and zinc 
chlorid in carefully adjusted proportions, with the necessary 
flavoring agents, not only produces the desired results, but it also 
conforms to the taste of most patients, and consequently insures 
continuous use. Chinosol is lauded by some recent writers as a 
harmless and powerful oral antiseptic ; the only objection we have 
found in its continuous use is the discoloration of metallic fill- 
ings. Saccharin, a sulpho-benzoic acid compound, is a very 
effective oral antiseptic, and is frequently prescribed. Its very 
persistent sweet taste, which, when daily used, becomes nauseating 
to many patients, materially restricts its general use. Miller's 
krameria-benzoic acid solution is largely prescribed, and deserves 
to be recommended. The objections made to the use of saccharin 
and benzoic acid solutions in regard to their solvent power on 
enamel is of little consequence; by actual tests in the mouth, 
extending over years of daily use, no observable disturbances could 
be recognized. 

Oral antiseptics exercise their beneficial influence on the soft 
and hard tissues of the oral cavity by inhibiting the activity of 
the extremely rich saprophytic flora which is always present. 
The increase of bacteria in the oral cavity is enormous, as the 
conditions which favorably influence their growth are ideal in 
this locality. According to Miller a single cell may reproduce 
in twenty-four hours 16,000,000 offsprings, while Novy has esti- 
mated that the amount of organic matter present in 30,000,000,000 
bacteria equals about 1 / 400 grain (0.00016 Gm.). The mere 
preservation of the teeth and their adnexa is not, however, the 



PREPARATIONS FOR THE MOUTH AND TEETH. 253 

only function of the antiseptics, as many other organs which are 
directly or indirectly connected with the oral cavity proper are 
frequently subjected to serious pathologic alterations, brought 
about by microbal disturbances, and they are also materially 
benefited by a strict oral hygiene. Oral sepsis, by way of con- 
tinuity, may involve the tonsils, the pharynx, the glands of the 
jaws and the mouth, the stomach, etc. According to Hunter 1 
septic gastritis and toxic neuritis, and their many sequelae, are the 
principal disturbances of a general nature brought about by oral 
sepsis. The local manifestations of oral sepsis vary greatly ; they 
are of an inflammatory and suppurative nature, and may involve 
the mouth, jaws, and the adjacent parts. The mixed infection of 
dental caries, as well as the many species of streptococci and 
staphylococci, are principally held responsible by Hunter as the 
causative factors of oral sepsis. 

Preparations which are intended to exercise a definite function 
on the teeth and gums, the oral mucous membrane, the tongue, 
the salivary glands, and the tonsils, and to some extent on the 
breath, are known as oralia. This term has, however, never been 
universally recognized ; the physical nature of the preparation has 
created specific names for definite classes — solid or semi-solid tooth 
preparations are known as dentifrices, liquid tooth preparations arc 
spoken of as collutoria, while liquids intended for the pharyngeal 
regions are referred to as gargles. Oral remedies are employed for 
the purpose of preserving and restoring the normal equilibrium 
of the oral tissues, and consequently no specific pharmacologic 
action is represented by each class of these preparations — they 
represent merely a combination of medicinal agents indicated for 
a clinical entity. According to their therapeutic indications, the 
drugs used in the mouth are grouped under abrasives, antacids, 
antiseptics, astringents, stimulants, and correctives. 

The preparations used for the mouth and teeth are conveniently 
divided into mouth washes, tooth powders, tooth pastes, and 
tooth soaps. Mouth pastils, cachous, and chewing gums are 
also used by the laity; they are intended to flavor the breath, 
and possess no medicinal value. 



1 Hunters Oral Sepsis. 1901. 



254 



PHARMACO-THERAPEUTICS, 



Drugs Used in the Mouth. 

The following is a list of drugs which are employed in mouth 
and tooth preparations, and their relative highest percentages in 
.100 parts of the finished product : 

Abrasives. 

Pumice stone 3 to 5 percent. 

Cuttlefish bone 3 to 5 percent/ 

Soap 3 to 5 percent. 

Cinchona bark 5 percent. 

Orris root 10 percent. 

Calamus root 10 percent. 

Calcium carbonate, precipitated. 60 to 100 percent. 

Antacids. 

Sodium bicarbonate 5 percent. 

Magnesium carbonate 10 percent. 

Magnesium oxid. 10 percent. 

Calcium carbonate, precipitated . 60 to 100 percent. 

Antiseptics. 

Mercuric bichlorid 0.05 to 0.1 percent. 

Formaldehyd solution 0. 1 to 0. 3 percent. 

Benzoic acid 1 percent. 

Sodium fluorid 1 to 3 percent. 

Hydronaphtol lto 5 percent. 

Resorcinol 1 to 5 percent. 

Salol 3 to 5 percent. 

Phenol 3 to 5 percent. 

Salicylic acid 3 to 5 percent. 

Magnesium dioxid 5 to 10 percent. 

Sodium perborate 5 to 10 percent. 

Strontium dioxid 5 to 10 percent. 

Boric acid 20 percent. 

Sodium borate 10 to 20 percent. 

Potassium chlorate 10 to 50 percent. 

Hydrogen dioxid solution 20 to 100 percent. 

Astringents. 

Zinc chlorid 0.05 to 0. 1 percent. 

Tannic acid 1 to 2 percent. 

Benzoin 5 percent. 

Catechu 5 percent. 

Kino 5 percent. 

Myrrh 5 percent. 

Rhatany root 2 to 10 percent. 



PREPARATIONS FOR THE MOUTH AND TEETH. 



255 



Stimulants. 

Oil of rose 0. 1 to 0.5 percent. 

Oil of ylang-ylang 0. 1 to 0.5 percent. 

Thymol 0. 5 percent. 

Oil of geranium 0.5 to 1 percent. 

Oil of cinnamon 1 percent. 

Oil of peppermint 1 percent. 

Menthol 1 percent. 

Oil of cloves 1 to 2 percent. 

Oil of eucalyptus , 1 to 2 percent. 

Eucalyptol 1 to 2 percent. 

Oil of mountain pine 1 tD 3 percent. 

Camphor 1 to 3 percent. 

Oil of wintergreen 1 to 5 percent. 

Methyl salicylate 1 to 5 percent. 

Alcohol 10 to 100 percent. 

Correctives. 

Saccharin 0.0003 percent. 

Cumarin 0. 5 to 1 percent. 

Vanillin 0. 5 to 1 percent. 

Glycerin 5 to 10 percent. 

Sugar of milk 10 percent. 



Action of Antiseptics in the Mouth. 

(W. D. MILLER.) 



Drugs 



Acid benzoic 

Acid boric 

Acid salicylic 

Eugenol 

Hydronaphtol 

Iodin trichlorid 

Lysol , 

Mercuric chlorid, corrosive 

Oil of cinnamon 

Oil of cloves 

Oil of eucalyptus 

Oil of mountain pine 

Oil of peppermint 

Oil of wintergreen 

Phenol 

Potassium chlorate 

Potassium permanganate . . 

Saccharin 

Solution aluminum acetate . 
Solution hydrogen dioxid. . . 
Thymol 



Dilution in which 

they can be employed 

in the mouth 



100 

50 

300 

750 

1,500 

2,000 
200 

2,500 
400 
550 
625 
3C0 
COO 
350 
100 
40 

4,000 

400 

20 

100 

2,000 



Time in which the 

mouth becomes 

sterilized 



i/i minute 
above 11 minutes 
% to 1 minute 
above 10 minutes 
above 15 minutes 
above l 1 /! minutes 
above 5 minutes 
V2 to % minute 
above 8 minutes 
above 11 minutes 
above 8 minutes 
above 19 minutes 
above 11 minutes 
above 12 minutes 
above 5 minutes 

above 15 minutes 
% minute 
above 5 minutes 
above 6 minutes 
above 5Va minutes 



256 



PHARMACO-THERAPEUTICS. 



Mouth Washes. 

A mouth wash is usually prescribed as a gargle, to be used in 
conjunction with the tooth brush. The components of the wash 
should be so adjusted that one teaspoonful mixed with half a 
tumblerful of warm water (approximately 1 to 30) furnish the 
correct proportions of its active ingredients intended for daily use. 
The gargling motion is produced by forcing air from the lungs 
through the fluid held posteriorly in the mouth. Powerful exer- 




FlGURE 20. 

Electric Heater and Spray Outfit. 

cise of the muscles of the pharynx, the cheeks, and the lips are 
material adjuncts in forcing the fluid back and forth through 
the teeth. About one-half to one minute's gargling is the average 
time required for each mouthful, corresponding approximately 
to V 2 to 1 fluidounce (15 to 30 Cc.) of liquid. Correct gargling 
is quite a difficult procedure ; it can not be accomplished by chil- 
dren and those afflicted with pharyngeal disturbances. Through 
incorrect gargling a quantity of the fluid is usually swallowed, or 



PREPARATIONS FOR THE MOUTH AND TEETH. 257 

it merely turns about in the anterior part of the mouth. If the 
fluids contain alcoholic or volatile solutions, more or less of it is 
always absorbed. 

A convenient way of spraying the oral cavity with a fluid anti- 
septic is readily accomplished by using an atomizer. This method 
of applying an antiseptic is especially of service before and after 
the removal of tartar and other operations about the mouth, in 
children, and in those who can not gargle. The atomizer bulb 
may be worked by hand or foot power, or, still better, by com- 
pressed air. An electric heater and spray outfit designed for 
dental purposes is now obtainable from the depots; in a compact 
form it comprises two adjustable spray tubes and a hollow needle 
for the purpose of conveniently carrying the fluid to all parts 
of the mouth, a tooth, pyorrhea pockets, the antrum, etc. The 
fluid in the spray bottles is kept at body temperature by a lighted 
electric bulb. The importance of this latter item is often over- 
looked; an antiseptic solution heated to body temperature will 
not only avoid unnecessary thermal shock, but will increase its 
own action materially. 

Tooth and mouth washes are usually dispensed in flint glass 

bottles, stoppered with corks or metallic sprinkler tops. If the 

latter are used, the contents of the bottle must not corrode the 

metallic tops. 

Antiseptic Mouth Wash. 

Boric acid 25 parts. 

Benzoic acid 1 part. 

Thymol 3 parts. 

Menthol 6 parts. 

Eucalyptol 5 parts. 

Oil of wintergreen 5 parts. 

Alcohol 250 parts. 

Glycerin 100 parts. 

Water. enough to make 1,000 parts. 

Dissolve the oil of wintergreen, eucalyptol, thymol, menthol, 
and benzoic acid in the alcohol; mix the glycerin and the water 
and add the boric acid; mix the two solutions, add 20 parts of 
talc, shake occasionally, and let stand for four days. Filter 
through paper. 

The solution reacts slightly acid. The quantities of benzoic 
and boric acid as represented in the formula have absolutely 



258 PHARMACO-THERAPEUTICSo 

no ill effect on the tooth structure or on the mucous membrane. 
If an alkaline mouth wash is desired, the following solution will 
answer the purpose. 

Alkaline Mouth Wash. 

Sodium bicarbonate 30 parts. 

Sodium benzoate 20 parts. , 

Sodium borate 50 parts. 

Menthol 6 parts. 

Thymol 3 parts. 

Eucalyptol 3 parts. 

Alcohol 100 parts. 

Glycerin 200 parts . 

Water enough to make 1,000 parts. 

Anatherin Dentifrice. 

Red sandal wood 20 parts. 

Guaiac wood 10 parts. 

Myrrh 25 parts. 

Cloves 15 parts. 

Cinnamon ... 5 parts. 

Oil of cinnamon 1 part. 

Oil of cloves 1 part. 

Alcohol 1,500 parts. 

Water 750 parts. 

Eatj de Botot. 

Star anise seed 25 parts. 

Cinnamon, Ceylon 25 parts. 

Cloves 25 parts. 

Cochineal 10 parts. 

Potassium bi tartrate 5 parts. 

Tannic acid 5 parts. 

Balsam of Peru 5 parts. 

Oil of peppermint 10 parts. 

Alcohol, diluted 1,000 parts. 

Pruyn's Mouth Wash. 

Borac acid 18 parts. 

Oil of cassia 6 parts. 

Phenol 6 parts. 

Chloroform 6 parts. 

Alcohol 150 parts. 

Oil of peppermint 1 part. 

Glycerin enough to make 400 parts. 



PREPARATIONS FOR THE MOUTH AND TEETH. 259 

Miller's Mouth Washes. 

1. 

Thymol 1 part. 

Benzoic acid 12 parts. 

Tincture of eucalyptus 60 parts. 

Alcohol 400 parts. 

Oil of peppermint 3 parts. 

2. 

Benzoic acid 60 parts. 

Tincture of rhatany 250 parts. 

Oil of peppermint 15 parts. 

Alcohol enough to make 2,000 parts. 

Resorcinol Mouth Wash. 

Boric acid 5 parts. 

Sodium borate 18 parts. 

Resorcinol 18 parts. 

Eau de cologne 200 parts. 

Water enough to make 500 parts. 

Fitzgerald's Mouth Wash. 

Glycerite carbolic acid, B. P 24 parts. 

Glycerite boric acid 24 parts. 

Potassium chlorate 12 parts. 

Euthymol 24 parts. 

Anise water 300 parts. 

Peppermint water enough to make 400 parts. 

Romer's Mouth Wash. 

Thymol 0.5 part. 

Menthol 0.5 part. 

Saccharin 0. 5 part. 

Alcohol 70 parts. 

Hydrogen dioxid solution 120 parts. 

Saccharin Mouth Wash. 

Saccharin 0. 5 part. 

Sodium borate 4 parts. 

Alcohol 50 parts. 

Water 50 parts. 

Tincture of cochineal V2 part. 

Oil of peppermint 1 part. 



260 PHARMACO-THERAPEUTICS. 

Astringent Hydrogen Dioxid Wash. 

Resorcinol 50 parts. 

Zinc chlorid 0.3 part 

Menthol 5 parts. 

Thymol 2 parts. 

Eucalyptol *4 part 

Camphor V± part. 

Oil of wintergTeen % part. 

Alcohol 250 parts'. 

Solution hydrogen dioxid 200 parts. 

Water enough to make 1,000 parts. 

Zederbatm's Chinosol Mouth Wash. 

Chinosol H part 

Glycerin 30 parts. 

Cassia water 30 parts. 

Water 240 parts. 



Colors for Mouth Washes. 

Bright red tincture of cochineal. 

Reddish-brown tincture of cudbear. 

Brown caramel solution. 

Golden yellow tincture of saffron. 

Green chlorophyl solution. 



Tooth Powders. 

Tooth powders, pastes, and soaps are principally employed for 
the purpose of mechanically cleansing the accessible surfaces of 
the teeth. Their antiseptic effect on oral bacteria is of question- 
able value, as they remain hardly long enough in the mouth to 
enter into a complete solution. Tooth powders or pastes should 
not contain gritty or fermentable substances or chemicals, which 
act deleteriously on tooth structure. The wasting away of tooth 
tissues, usually referred to as erosion or abrasion, is largely the 
result of the continuous use of powders, pastes, etc., which contain 
more or less abrasive substances, as the late Miller has shown. In 
a recent communication Miller 1 deducts the following conclusions 
from his experimental work: 



1 Miller: Experiments and Observations on the Wasting of Tooth Tissue, Variously Desig- 
nated as Erosion, Abrasion, Chemic Abrasion, Denudation, etc., Dental Cosmos, 1907. 



PREPARATIONS FOR THE MOUTH AND TEETH. 261 

"With some of the much extolled preparations on the market it is quite 
easy, by applying the brush as nearly as possible in the same manner as it 
would be used in the mouth, to cut the tooth half through, exposing the 
pulp, inside of two hours. ... In fact, I was not satisfied with examin- 
ing the preparations microscopically, but where there was any doubt I 
tested them by brushing the teeth with them. Of the dentifrices examined 
a considerable number cut teeth rapidly; while nearly all the others cut the 
teeth to some extent, the one that cut the least of all that I have examined 
was one which consists almost wholly of sodium bicarbonate. I was sur- 
prised to find that even precipitated chalk wore the dentin away rapidly; 
but this, one can understand in view of the fact that the substance consists 
of a mass of fine crystals, which, although they are very small, are still 
sharp, and sufficiently hard to abrade the dentin. Prepared chalk acts on 
the teeth with a rapidity depending on the amount of impurities which 
it contains. We shall find on washing out prepared chalk that, among dif- 
ferent preparations, some contain considerable quantities of remains of 
shells and other gritty substances, which make them unfit for use as tooth 
powder. Other preparations which are comparatively free from these 
impurities act more slowly upon the dentin." 

The materials which are principally employed in the manu- 
facture of commercial tooth powders, pastes, and soaps are pre- 
pared chalk, precipitated calcium carbonate, magnesium carbonate, 
pumice stone, cuttlefish bone, orris root, and many other sub- 
stances — as vegetable powders of various kinds, borax, boric acid, 
potassium bitartrate. alum, charcoal, etc. Some of these sub- 
stances possess a pronounced abrasive character, while others are 
polishing agents consisting of various degrees of grit. The vege- 
table powders are principally used as adjuvants and diluents: 
their use in tooth powders is not to be encouraged, as they may 
lodge between the teeth, and the starch, which is present in 
most of these powders in variable quantities, may be the cause 
of acid fermentation. 

An acquaintance with the physical nature of the ingredients 
entering into the makeup of tooth preparations in regard to their 
abrasive qualities is essential for the dental practitioner. A micro- 
scopic examination of the more important powdered substances, 
together with a comparative knowledge of their physical and 
chemic composition, furnishes excellent information regarding 
their usefulness as components of dentifrices. 

Prepared chalk, drop chalk, trhiting, creta przeporata, a white 
amorphous powder, is crude calcium carbonate, purified by me- 



262 



PHARMACO-THERAPEUTICS. 



chanical means. Prepared chalk is not precipitated chalk (cal- 
cium carbonate, precipitated). Prepared chalk contains also 
silica, alumina, and other impurities, and consists principally of 
the microscopic shells of many forms of infusoria. The minute 
particles of prepared chalk are sufficiently hard and sharp to re- 




FlGURE 21. 



Magnified Specimens of Tooth Powder Substances. Magnification, 350x. A, powdered 
pumice stone; B, powdered cuttlefish bone; C, powdered charcoal; D, powdered potassium 
bitartrate. 

move tooth substance when used in a dentifrice, and should there- 
fore not be employed for such purposes. 

Precipitated chalk, precipitated calcium carbonate, calcii car- 
bonas prsscipitatus, is a fine white, amorphous powder, prepared 
by chemic means. Depending upon the process of manufacture, 
various grades of fineness, weight, and color are obtained. For 



PREPARATIONS FOR THE MOUTH AND TEETH. 



263 



the purpose of preparing tooth powders, pastes, etc., only the very 
finest bolted precipitated calcium carbonate is permissible. 

Prepared oyster shells, concha preparata, testa preparata, are 
prepared from the boiled, cleansed, and powdered shells of the 
oyster, Ostrea edulis. They consist principally of an impure cal- 






FlGURE 22. 

Magnified Specimens of Tooth Powder Substances. Magnification, 350x. A, powdered 
magnesium carbonate; B, powdered prepared chalk; C, precipitated calcium carbonate, heavy; 
D, precipitated calcium carbonate, washed. 



cium carbonate, with variable quantities of calcium phosphate, and 
small amounts of iodin, bromin, organic matter, etc. The powder 
usually emits a peculiar sea odor. The abrasive power of pow- 
dered oyster shells is about equal to that of prepared chalk, and 
the same objection is raised to their use as a tooth powder base 
as to the latter. 



264 



PHARMACO-THERAPEUTICS. 



Pumice stone, lapis pumicis, is a light, porous stone of volcanic 
origin, consisting chiefly of silica, with potash and soda. As 
may be expected from its composition, it is a powerful abrasive, 
and it should never enter into a tooth preparation intended for 
daily use. Even its temporary use in conjunction with precipi- 
tated chalk acts deleteriouslv on tooth structure. 




Figure 23. 

Magnified Specimens of Tooth Powder Substances. Magnification, 350x. A, precipitated 
calcium carbonate (precipitated by heat); B, precipitated calcium carbonate (Schering's) ; 
C, powdered orris root; D, borax tooth powder. 



Magnesium carbonate, magnesii carbonas. Two forms of mag- 
nesium carbonate are known — the light and the heavy. The light 
preparation is usually employed for tooth powder purposes. It 
has no abrasive or polishing action on tooth structure. As it is 



PREPARATIONS FOR THE MOUTH AND TEETH. 



265 



a voluminous powder, it is principally used to give bulk to tooth 
powders. Burnt magnesia, Magnesia usta, is prepared from 
magnesium carbonate by calcination. It possesses no advantage 
over magnesium carbonate, and is rarely used at present as a 
component of dentifrices. 




Figure 24. 

Magnified Specimens of Tooth Powder Substances. Magnification, 350x. A, B, C, D, some of 
the more widely used commercial tooth powders, of which D is an especially fine preparation. 

Cuttlefish bone, ossa sepise, is a calcareous substance found 
under the skin of the back of the cuttlefish, Sepia officinalis. It 
is composed of calcium carbonate, calcium phosphate, gluten, and 
other substances which are readily recognized by their peculiar 
putrid odor. The external hard skin and the internal soft de- 
posits of the cuttlefish bone are ground together, forming a 
powder, which is used as an abrasive. 



266 PHARMACO-THERAPEUTICS. 

Charcoal, carbo ligni, carbo tilise, is a very fine black powder 
prepared from soft wood (linden wood). It is odorless and 
tasteless, and, when freshly prepared, readily absorbs offensive 
odors. Even the finest charcoal powder presents a mass of sharp 
crystalline cylinders under the microscope, which possess marked 
abrasive power. When used as a component in a tooth powder, 
the sharp particles imbed themselves in due time in the gum 
tissue, producing a distinct blue line near the margin, which 
may simulate the typical lead line. The gum tissue becomes 
tattooed by the charcoal, and nothing can remove this pigmenta- 
tion but a surgical operation. Charcoal should not be used in a 
tooth powder preparation; it is often found in the so-called 
Chinese and Japanese tooth powders. 

Powdered vegetable drugs — as the roots of calamus* rhatany, 
licorice, and orris, cinchona bark, sandal wood, myrrh, benzoin, 
etc. — have no place in tooth powders. As stated above, they are 
added to give flavor to the powder or to increase its bulk. The 
odor and taste of these vegetable substances is readily substituted 
by their respective essential oils or alcoholic extracts. The short 
time in which a tooth powder remains in the mouth is not long 
enough to allow the active constituents of these substances to enter 
into solution. Their abrasive action is of no value, but, as these 
vegetable powders may be forced between the teeth and remain 
there for some time, their starch constituent may give rise to acid 
fermentation. 

Tooth powders are preferably dispensed in glass bottles or tin 
cans with suitable sprinkler tops. 

Bodies for Colored Tooth Powders. 

red. 

Carmin No. 40 20 parts. 

Ammonia water 50 parts. 

Water 20 parts. 

Alcohol 30 parts. 

Calcium carbonate, precipitated 1,000 parts. 

Dissolve the carmin in the ammonia water, add the water 
and alcohol, and mix thoroughly with the calcium carbonate. 
Spread on paper and dry at room temperature; rub through a 
No. 50 brass wire sieve. 



PREPARATIONS FOR THE MOUTH AND TEETH. 267 

PINK. 

Prepare same as red body, using only one-half of the carmin, 
10 parts. 

VIOLET. 

Alkannin 2^ parts. 

Ether 100 parts. 

Calcium carbonate, precipitated, 1,000 parts. 

Prepare same as red body. 

Camphor or English Tooth Powder. 

Calcium carbonate, precipitated 750 parts. 

Magnesium carbonate 120 parts. 

Sugar of milk 130 parts. 

Camphor 20 parts. 

Ether 30 parts. 

Dissolve the camphor in the ether, mix with the calcium car- 
bonate, dry in the air, and mix with the other ingredients. 

Fitzgerald's Tooth Powder. 

Calcium carbonate, precipitated 360 parts. 

Magnesium carbonate 300 parts. 

Castile soap 150 parts. 

Salol 60 parts. 

Boric acid 30 parts. 

Thymol 2 parts. 

Saccharin V% part. 

Oil of peppermint 5 parts. 

Harlan's Tooth Powder. 

Calcium carbonate, precipitated 100 parts. 

Orris root 100 parts. 

Castile soap 25 parts. 

Sodium bicarbonate 25 parts. 

Myrrh 100 parts. 

Oil of wintergreen 10 parts. 

Lasar's Tooth Powder. 

Calcium carbonate, precipitated 100 parts. 

Sodium chlorid 2Y2 parts. 

Pumice stone 2 1 / £ parts. 

Castile soap 3 parts. 

Oil of peppermint 1 part. 



268 PHARMACO THERAPEUTICS. 

Miller's Tooth Powder. 

Calcium carbonate, precipitated 30 parts. 

Magnesium carbonate 10 parts. 

Orris root 15 parts. 

Oil of peppermint % part. 

Oxydizing Tooth Powder. 

1. 

Calcium carbonate, precipitated 75 parts. 

Magnesium carbonate 10 parts. 

Sodium perborate 10 parts. 

Castile soap , 3 parts. 

Oil of peppermint 1 part. 

2. 

Calcium carbonate, precipitated 90 parts. 

Strontium dioxid 8 parts. 

Castile soap 3 parts. 

Oil of wintergreen 1 part. 

Oil of peppermint y 2 part. 

Cook's Oxydizing Tooth Powder. 

Magnesium oxid 50 parts. 

Calcium carbonate, precipitated . 100 parts. 

Magnesium dioxid 20 parts. 

Menthol 2 parts. 

Saccharin 1 part. 

Oil of peppermint : 2 parts. 

Pedley's Tooth Powder. 

Calcium carbonate, precipitated 1,000 parts. 

Orris root 250 parts. 

Castile soap 125 parts. 

Boric acid 125 parts. 

Phenol 30 parts. 

Oil of eucalyptus 25 parts. 

Red Tooth Powder. 

Red tooth powder body 1,000 parts. 

Orris root 300 parts. 

Sugar of milk 200 parts. 

Oil of cloves 50 drops. 

Oil of peppermint 50 drops. 



PREPARATIONS FOR THE MOUTH AND TEETH. 269 

Fletcher's Vegetol Tooth Powder. 

Pulverized cereal 75 parts. 

Sodium borate 18 parts. 

Potassium chlorate 7 parts. 

Sweeten with saccharin and flavor to taste. 

Violet Tooth Powder. 

Violet tooth powder body 650 parts. 

Sugar of milk 100 parts. 

Orris root 200 parts. 

Licorice root 25 parts. 

Cumarin X A part. 

Extract of jasmine 10 parts. 

Oil of rose 1 part. 

Tooth Pastes. 

A perfectly satisfactory tooth paste can not be produced with- 
out the use of gelatin or mucilage of acacia. Pastes which are 
massed with pure glycerin are disappointing; the latter oozes 
from the tube, discoloring the label and forming an unsightly 
package. Glycerin is necessary, but it should never be employed 
alone. Glucose should never be used as a massing fluid, as it 
will easily ferment. The consistency of the excipient or massing 
fluid determines the character of the paste. If formaldehyd solu- 
tion is added to a gelatin massing fluid, the latter is changed to 
an insoluble compound. 

Massing Fluids. 

Gelatin 1 part. 

Glycerin 25 parts. 

Water 40 parts. 

Dissolve the gelatin in the water with the aid of gentle heat 
and add the glycerin. 

Another massing fluid is made by mixing : 

Glycerin 200 parts. 

Mucilage of acacia 200 parts. 

Mucilage of acacia is made by dissolving: 

Gum arabic 4 parts. 

Water 6 parts. 

Dissolve the gum arabic in the water, and strain through a 
fine cotton cloth. 



270 PHARM ACO-THERAF EUTICS. 

Tooth pastes may be prepared according to this general formula : 

Tooth powder body 100 parts. 

Massing fluid 300 to 400 parts. 

The paste is best dispensed in collapsible tubes made of pure tin. 

Harlan's Tooth Paste. 

Calcium carbonate, precipitated 1,500 parts. ' 

Sodium fluoro-silicate 250 parts. 

Tannic acid 30 parts. 

Sugar 750 parts. 

Cuttlefish bone 250 parts. 

Oil of wintergreen 10 parts. 

Massing fluid enough to make a paste. 

Miller's Tooth Paste. 

Calcium carbonate, precipitated 100 parts. 

Magnesium carbonate 5 parts. 

Cuttlefish bone 4 parts. 

Sugar 2 parts. 

Myrrh 2 parts. 

Massing fluid enough to make a paste. 

Kolynos Tooth Paste. (Jenkins.) 

Soap 33 parts. 

Calcium carbonate, precipitated 25 parts. 

Absolute alcohol 20 parts. 

Glycerin 15 parts. 

Benzoic acid 3 parts. 

Oil of eucalyptus 2 parts. 

Oil of peppermint 2 parts. 

Saccharin % part. 

Thymol % part. 

Salinb Tooth Paste. 

Artificial Carlsbad salt 1 part. 

Powdered Castile soap 1 part. 

Calcium carbonate, precipitated 3 parts. 

Massing fluid enough to make a paste. 



PREPARATIONS FOR THE MOUTH AND TEETH. 271 

Tooth Soaps. 

Hard Tooth Pastes or Tooth Soaps. 
Tooth soaps are usually prepared by incorporating about 20 
percent of Castile soap in solution into the powder base and 
pressing the mass into suitable molds; their hardness increases 
with age. Tooth soaps are usually dispensed in flat tin boxes, 
china jars, or wrapped in tin foil. 

Austrian Tooth Soap. 

Castile soap 200 parts. 

Calcium carbonate, precipitated 80 parts. 

Carmin 2 parts. 

Oil of peppermint 5 parts. 

Alcohol 30 parts. 

Bergmann's Tooth Soap. 

Transparent glycerin soap 50 parts. 

Sugar 25 parts. 

Alcohol 20 parts. 

Water 10 parts. 

Oil of peppermint 1 part. 

Dissolve the soap and sugar in the alcohol. 

Robert's Tooth Soap. 

Magnesium carbonate 50 parts. 

Orris root 50 parts. 

Talcum 50 parts. 

Castile soap 50 parts. 

Oil of wintergreen 3 parts. 

Thymol Tooth Soap. 

Pink tooth powder body 750 parts. 

Castile soap 200 parts. 

Glycerin 50 parts. 

Alcohol 100 parts. 

Thymol 10 parts. 

Cumarin ^2 part. 

Menthol 10 parts. 

Oil of cloves 5 parts. 

Soap, glycerin, and alcohol are mixed to a paste, and th<j 
other ingredients are incorporated. Press in suitable molds, 
expose to the air for twenty-four hours and paint the pieces 
with tincture of benzoin to give a gloss to the finished product. 



272 PHARMACO-THERAPEUTICS. 



LOCAL ANESTHETICS AND OBTUNDENTS. 

Local anesthetics (without pain) are agents which are em- 
ployed for the purpose of producing insensibility to pain in a cir- 
cumscribed area of tissue. They are known to act in two ways. 
Primary, or true local, anesthetics are those which act at once on 
the nerve endings ; and secondary, or painful, anesthetics are those 
which are preceded in their anesthetic action by a period of in- 
tense irritation. The latter group is principally represented by 
the salts of the alkalies and the alkaline earth metals — potassium 
and sodium bromid, etc. Painful anesthetics are not employed in 
the form of hypodermic injections. Certain essential oils which 
belong to the group of painful anesthetics possess valuable obtund- 
ing properties, and they are frequently employed for such pur- 
poses in dentistry. Specific forms of local anesthesia may also be 
produced by paralyzing the sensory ganglia in the brain or in the 
spinal cord; these methods have, however, no bearing on the sub- 
ject under consideration. 

Local anesthetics produce insensibility to pain. By pain we 
understand the conscious manifestation of morbid changes within 
the nerve centers caused by some form of irritation. At present 
three specific sets of nerves are recognized as being the means 
which convey the sensation of cold, of heat, and of pressure and 
touch; consequently the local inhibition of the functions of these 
three sets of nerves is necessary to produce insensibility within 
a circumscribed area. Local anesthetics must be absorbed to pro- 
duce their typical effect; the mucous membranes are easily pene- 
trated by topically applied anesthetic solutions, and superficial 
anesthesia is readily produced. The horny layer of the skin does 
not allow penetration ; endodermic or hypodermic injections are 
necessary to bring the anesthetic solution into close contact with 
the nerve endings. To prevent a too rapid absorption by the blood 
and by the lymph stream, blocking of the circulation within the 
injected area is essential. The application of a suitable bandage 
applied near the seat of the anesthetic field and the injection of 
powerful vaso-constrictor drugs incorporated in the anesthetic so- 



LOCAL ANESTHETICS AND OBTUNDENTS. 273 

lution are both effective. To prevent unnecessary damage to the 
cells, the solution must correspond to the isotonic index of the 
tissue fluids. 

Circumscribed areas of the skin and accessible parts of the 
mouth may be locally anesthetized by physically reducing their 
temperature by abstracting heat; agents used for such purposes are 
termed refrigerants. A protracted warm bath is frequently of 
benefit in reducing hypersensation of the skin. Protectives ap- 
plied over painful wound surfaces act to some extent as local 
anesthetics. 

Local anesthesia, according to Preyer's conception, is produced 
as follows: Cocain possesses a distinct affinity for the living 
protoplasm of the nerve cell ; it enters with it into a labile union, 
thus producing local anesthesia, which lasts until this temporary 
union is broken up by releasing the chemical — not as the original 
cocain, however, but as an inert compound of a simpler structure. 
In other words, the living tissues rid themselves of the poison in 
some unknown manner. In dead tissues the injected cocain will 
not undergo any change. 

Numerous instances in pharmacology in which an alcohol radi- 
cal in an ester-like combination with an acid is required to bring 
about any specific effect may, according to Pauli, 1 be explained 
in this way: 

"The alcohol radical only renders possible the ready absorption of the 
substance by the cell; the anion connected with it is the real active prin- 
ciple. Cocain is, for example, a methyl ester-benzoyl-ecgonin, a substituted 
tropincarbonic acid. The benzoyl-ecgonin, the real carrier of the medicinal 
property, is, however, twenty times less poisonous than its ester, cocain, 
and does not possess the anesthetic properties of the latter. Only after 
being converted into an ester, through any alcohol whatsoever, is the cocain 
effect produced. Existence in the form of an ester is apparently always 
the sine qua non of a useful local anesthetic whose active anion must enter 
the endings of the sensory nerves. Einhorn has found that a large number 
of cyclic and heterocyclic esters are liable to bring about a local anesthesia, 
and has been able to discover valuable substitutes for cocain in the ortho- 
forms, which represent methyl esters of amido-oxybenzoic acid, and in 
nirvanin, a diethylglycocoll compound of orthoform. Eucain and anesthesin 
are also esters, the latter one of a p-amido-benzoic acid. We being directly 
concerned in the physiologic effect produced, the presence of. an alcohol 



] Pauli: Physical Chemistry in the Service of Medicine, 1907, p. 96. 



274 PHARMACO-THERAPEUTICS. 

radical in the compound first renders such an effect possible, for only under 
these circumstances is the active ion present in sufficient concentration at 
its point of physiologic contact." 

Local anesthesia is indicated in all minor and in relatively many 
major operations on the mucous surfaces, the skin, and the teeth. 
Certain reflex disturbances — vomiting from an irritated stomach 
or hyperesthesia of the mucous membrane of the mouth during 
taking of an impression, and many forms of neuralgia — are fre- 
quently benefited by the application of local anesthetics. Recent 
observations made by Spiess, 1 Rosenbach, 2 Fischer 3 and Kirchner 4 
have fully demonstrated the therapeutic value of local anes- 
thetics in the abortive treatment of inflammation. Inflamma- 
tion in its early stages, according to Spiess, may be completely 
aborted if it is possible to prevent the occurrence of pain. Spiess 
applies local anesthetics on the seat of inflammation, while Rosen- 
bach advocates general analgesics, such as morphin, for this pur- 
pose. The advantages of local therapeutic applications in dental 
surgery for the above purposes is apparent, and Fischer and 
Kirchner have frequently made use of Spiess' suggestion. The 
beneficial influence of local anesthetics on inflammatory processes 
are explained by Spiess as follows : When the exposed nerve fibers 
are brought in direct contact with the anesthetic, they become at 
once insensible, but the anesthetic must not interfere with the 
blood vessels — they must not act as vaso-constrictors. The im- 
portant factor in this treatment seems to be to bring and to hold 
the local anesthetic in close contact with the wound surface until 
all subjective pain is more or less abolished, and to keep the wound 
surface in this analgesic state. Cocain, as it possesses marked vaso- 
constrictor power, is not well adapted for this purpose, but novo- 
cain, made into a paste with water and placed on the painful 
wound surface, apparently materially enhances the progress of 
wound healing. Fischer and Kirchner recite a number of cases 
in which this treatment has been applied with marked benefit to 
painful sockets after tooth extraction. These statements are fully 

1 Spiess: Miinchener Medizinische Wochenschrift, 1906, No. 8. 

2 Rosenbach: Miinchener Medizinische Wochenschrift, 1906, No. 18. 

3 Fischer: Deutsche Monatsschrift fur Zahnheilkunde, 1907, No. 4. 

4 Kirchner: Deutsche Zahnarztliche Wochenschrift, 1907, No. 28. 



LOCAL ANESTHETICS AND OBTUNDENTS. 275 

corroborated by our own observations. Novocain, being free from 
all irritation to soft tissues, is preferably employed instead of 
orthoform; the latter has been recommended for the above pur- 
poses for some time past, but when it is used too freely it is liable 
to produce sloughing of the tissues. 

Local anesthesia is not a substitute for general anesthesia; its 
usefulness is materially increased by familiarizing one's self 
with the modern methods of its production and with a per- 
fect mastering of the technique. The danger of poisoning has 
been practically eliminated by using isotonic solutions containing 
a relatively small percentage of the anesthetic in combination with 
the alkaloid of the suprarenal capsule. Even if the danger of gen- 
eral narcosis is small under the very best conditions, the danger 
from local anesthesia is always less. The greater majority of all 
dental operations can be safely carried out under local anesthesia, 
provided the operator has acquired a complete working knowledge 
of the various components which, as a whole, constitute this im- 
portant branch of dental therapeutics. 

For the sake of convenience, local anesthetics are divided into : 

1. Soluble local anesthetics. 

2. Insoluble local anesthetics. 

3. Refrigerant local anesthetics. # 

Soluble Local Anesthetics. 

Cocain Hydrochlorid ; Cocaine Hydrochloridum, U. S. P., 
B. P.; C 17 H 21 N0 4 .HC1; Methyl-benzoyl-ecgonin; Chlor- 

HYDRATE DE COCAINE, F. ; SALZSAURES KOKAIN, G. 

Source and Character. — It is the hydrochlorid of the alkaloid 
cocain obtained from several varieties of Coca. It appears in color- 
less crystalline flakes or scales, or as a white crystalline powder, 
odorless, having a saline, slightly bitter taste, and producing on 
the tongue a tingling sensation, followed by numbness. It is 
soluble in 0.4 parts of water, 2.6 parts of alcohol, 18.5 parts of 
chloroform, and in glycerin ; it is readily soluble in hot water, but 
insoluble in ether, petroleum benzin, and olive oil. It melts at 
about 375° F. (190° C). Its aqueous solution reacts neutral to 



276 PHARMACO-THERAPEUTICS. 

litmus paper. Prolonged heating of the salt or its solution decom- 
poses it into methyl-alcohol, benzoic acid, and ecgonin. It is in- 
compatible with alkaline hydrates or carbonates, salicylates, ben- 
zoates, bromids, iodids, the mercury salts, and silver nitrate. 

Cocain solution may be preserved for a reasonable length of 
time by adding to it 1 / 2 percent boric acid, or by making the solu- 
tion with camphor water. Mercuric chlorid can not be added for 
this purpose, as it will combine with cocain, forming a double salt. 
Fractional sterilization of the solution is serviceable; ijt is accom- 
plished by using the autoclave and subjecting the solution to 
176° F. (80° C.) for twenty minutes at a time on three successive 
days." 

The coca plant, Erythroxylon coca, is principally found in Peru 
and Bolivia, where it has been cultivated from time immemorial. 
It has played an important mission in the religious and political 
life of the aborigines. The coca plant is regarded by the Indians 
of South America as a divine gift, which "satisfies the hungry, 
strengthens the weak, and supplies new vitality to the exhausted, 
while the unhappy are made to forget their troubles." The Inkas 
restricted to the royal families the right to cultivate and use the 
coca leaves. With the conquest of Peru by Pizarro (1532) the 
Spanish fii*t monopolized and later levied a heavy tax on coca 
leaves, which became a rich source of income to the Spanish 
crown. The aborigines of South America chew the coca leaves 
mixed with alkalies, usually wood ashes, to facilitate the ready 
solution of the alkaloids. The stimulating action of the cocain, 
which makes them endure greater physical labor and elude tem- 
porarily the necessity of sleep, is well known to the South Ameri- 
can Indians; they are also acquainted with the dangers of its too 
freely indulgence. 

The small green or greenish-brown leaves of the coca plant are 
plucked from the shrub, dried in the sun, and immediately 
packed for shipment. Niemann and Lossen, working in Woh- 
lere's laboratory in Gottingen, were the first to isolate cocain. 
Later on it was synthetically prepared by Merck, Liebermann, 
and Giesel. The first records of the anesthetic properties of cocain 
were published by Scherzer, followed by Niemann (1860) and 



LOCAL ANESTHETICS AND OBTUNDENTS. 277 

others. Von Anrep, in 1878. published the first detailed report 
of its definite local anesthetic properties on the eye and other 
tissues. It remained for Roller, however, to introduce it per- 
manently into surgery through his communication addressed to 
the Ophthalmologic Congress held in Heidelberg in 1884. Cocain 
was now readily accepted by the profession at large, and very 
soon it became the most important drug for the purpose of pro- 
ducing local anesthesia. 

As dental surgery has to deal so much with pain, it is not at all 
surprising that cocain has been so quickly admitted to this spe- 
cial field of surgery. Hillischer published his experiments in 
1884. which were soon followed by Hughes. Audina. David. Bar- 
ker, and others. The most complete essays on the use of cocain in 
dentistry, which materially assisted in making the drug widely 
known in dental circles, were published in 1886. Adolph Witzel, 
of Essen, presented a valuable contribution in German, which was 
followed a few months later by a similar essay by George Yiau. of 
Paris. Witzel advocated a 20-percent solution, using one grain of 
cocain of a questionable purity for one injection. It is surprising, 
indeed, that not more serious intoxications from such enormous 
concentrations and quantities have occurred. (See Local Anes- 
thesia.) 

Average Dose. — y 2 grain (0.03 Gm.). 

Preparations. — 

Cocain Phenate; Cocainss Phenolis; Phenol-Cocain; Cocain Car- 
bolate. It represents semi-solid, almost colorless, partly crystalline 
masses, and is soluble in alcohol and ether, but insoluble in water. 

Fluidextract of Coca; Fluidextractum Cocse, U. S. P. : Eximctum 
Cocas Liquidum, B. P. Average dose. 30 minims (2 Ce.). 

Wine of Coca: Vinum Cocx. U. S. P. Average dose. 4 fluidrams 
(16 Cc). 

Oleate of Cocain; Oleatum Cocainse, U. S. P. It contains o 
percent of the alkaloid. 

Xeurocain is a special term given to small billets composed of 
pure cocain hydrochlorid. weighing 1 / 12 grain each. 

Therapeutics. — Cocain is principally used as a local anesthetic, 
especially for operative purposes, and rarely as a curative agent. 



278 PHARMACO-THERAPEUTICS. 

Anesthetization in minor surgery, and in surgical interferences 
with the eye, external ear, nose, throat, and the oral cavity, de- 
pends almost exclusively on cocain and its substitutes. On mucous 
linings it is frequently applied topically, but for deeper anesthesia 
hypodermic injection is necessary. The latter is usually prepared 
by adding to a physiologic salt solution sufficient cocain hydro- 
chlorid to make a 1-percent solution. (See Local Anesthesia.) 

Cocain is a protoplasm poison, producing typical effects when- 
ever it is brought in contact with the living tissue. It .causes pro- 
nounced constriction of the smaller vessels, resulting in anemia of 
the affected area. Its specific action is manifested by paralyzing 
the sensory nerve endings without primary irritation. On the 
skin it has no action, but when injected into it, or when absorbed 
from the mucous membranes, its anesthetic action is quickly pro- 
duced. The anesthesia lasts as long as the cocain remains in di- 
rect contact with the nerve endings; about fifteen minutes is the 
average time of an anesthesia produced by V 2 cubic centimeter of a 
1-percent solution injected into normal tissues. The anesthesia 
diminishes with the absorption of the cocain by the body fluids. 
The production of anesthesia depends on the decomposition of the 
cocain. 

The average concentration of a solution for anesthetic pur- 
poses to be used in the gum tissue should be 1 percent. The other 
tissues of the oral capacity are readily anesthetized by a 1 / 2 -ipeYcent 
solution. If a cocain solution is injected so as to encircle a nerve 
trunk, anesthesia of the sensory fibers of the entire trunk is pro- 
duced — regional anesthesia. By injecting cocain solution into the 
spinal canal, a complete anesthesia of the sensory as well as of the 
motor centers (the latter only transitory) is produced, lasting from 
one to two hours — spinal anesthesia. Cocain is quickly absorbed 
by the tissues and carried away by the blood, resulting in intense 
disturbances of the central nervous system. Small doses produce 
a rapid pulse and increase the respiration, while large doses para- 
lyze the centers of respiration. 

Toxicology. — The typical picture of cocain poisoning is pro- 
duced when the blood flowing through the central nervous sys- 
tem contains a sufficient quantity of the drug, even for the mo- 



LOCAL ANESTHETICS AND OBTUNDENTS. 279 

ment only, which is dangerous to this organ. No maximum dose 
of cocain can be positively established; this is equally true of 
chloroform and ether when used for general anesthesic purposes. 
The many cases of so-called idiosyncrasy probably find an ex- 
planation in the too large doses which formerly were so frequently 
administered. 

The danger of poisoning with cocain preparations has been 
practically eliminated with our increased knowledge of its action 
on the tissues. At present solutions containing a relatively small 
percentage combined with adrenalin are usually employed, and, 
when injected with the proper technique, dangerous results are 
comparatively rare. No direct antidotes of cocain are known. 

The treatment of general intoxication is purely symptomatic. 
Anemia of the brain, which is of little consequence, may be 
readily overcome by placing the patient in a recumbent position, 
or by complete inversion if necessary. As a powerful dilator of 
the peripheral vessels, the vapors of amyl nitrite 1 are exceed- 
ingly useful ; it is best administered by placing 3 to 5 drops of the 
fluid on a napkin held before the nostrils for inhalation. Flush- 
ing of the face and an increase in the frequency of the pulse fol- 
lows almost instantly. Nausea may be remedied by administering 
small doses of spirit of peppermint, aromatic spirit of ammonia, 
or validol. The latter is a compound of menthol and valerianic 
acid, and deserves special recommendation. To overcome the dis- 
turbances of respiration, quickly instituted artificial respiration is 
the alpha and omega of all methods of resuscitation ; the only drug 
that has proved to be of value in this connection is strychnin in 
the form of the sulphate or the nitrate in full doses by means of 
hypodermic injections. 

Cocainism. — The repeated administration of cocain may 
readily establish an addiction to this drug, known as cocainism or 
cocain habit. The exhilarating effect of cocain on the nervous 
system, euphoria, is largely responsible for the craving for the 
drug. The treatment of chronic morphinism by substituting co- 
cain for the former drug often results in developing an irresistible 



1 For convenience, amyl nitrite may be procured in small glass capsules holding the neces- 
sary quantity for one inhalation. 



280 PHARMACO-THERAPEUTICS. 

desire for cocain or for both alkaloids. Cocain habitues are very- 
insistent upon the mode of administration of the poison. Whether 
they take this drug by insufflation or by injection, or even by the 
rectum, they will always strenuously insist upon the particular 
method they originally adopted. Usually the hypodermic injec- 
tion is preferred by the white race, while the negro prefers to snuff 
his cocain. The continuous puncturing with the needle in inject- 
ing cocain into the tissues produces an injurious effect on the skin 
in the cocain habitue ; abscesses form, and the resulting scars fre- 
quently cover all available spaces of the body, especially the arms 
and the legs. Cocainism usually manifests itself in disturbed 
digestion, salivation, and emaciation, the most important changes 
occurring in the nervous system. Sleeplessness and tremors, and 
occasionally convulsions, hallucinations, insanity, and delirium, 
have been noted after long abuse, along with indefinite dis- 
turbances of sensation and motion. 

While the addiction to cocain is very appalling, cocainism ap- 
parently yields very readily to treatment. Sanitarium treatment, 
with the proper medical care, is the most efficient method for the 
eradication of the habit. 

Local Anesthetic Solution. 

J$l Cocainae hydrochloridi gr. v (0.32 Gm.) 

Sodii chloridi gr. iv (0.25 Gm. 

Aquae destillat. fl§ j (30 Cc.) 

M. 

Sig. : Cocain injection for dental purposes. To each cubic 
centimeter add 1 drop of adrenalin solution when used. 

Local Obtundents. 

$. Cocainae hydrochloridi gr. xv (1.0 Gm.) 

Phenolis liquid. 3 J (4 Cc.) 

M. 

Sig. : Apply the heated solution to hypersensitive dentin. 

(Jenkins. ) 

$. Cocainae gr. xx (1.3 Gm.) 

Chloroformi fl^ ij (8 Cc.) 

Athens fig j (30 Cc.) 

M. 

Sig. : Apply to the cavity on a small pledget of cotton 
and evaporate to dryness. (Buckley.) 



n 



LOCAL ANESTHETICS AND OBTUNDENTS. 281 

Novocain ; Novocaina ; P-aminobenzoyldiethylaminoethanol 
Hydrochlorid; COO.C 2 H 4 N(C 2 H 5 )2.NH 2 HCl. 

Source and Character. — Novocain is the hydrochloric salt of 
a synthetically prepared alkaloid, the methyl ester of p-aminoben- 
zoic acid. It is a white crystalline powder, or colorless needle- 
shaped crystals, melting at 263° F. (156° C). It may be heated 
to 200° F. (120° C.) without decomposition. It dissolves in an 
equal amount of cold water, the solution having a neutral char- 
acter ; in cold alcohol it dissolves in the. proportion of 1 to 30. 
Caustic alkalies and alkaline carbonates precipitate the free base 
from the aqueous solution in the form of a colorless oil, which soon 
solidifies. It is incompatible with the alkalies and alkaline car- 
bonates, with picric acid, and the iodids. 

Average Dose. — 1 / 2 grain (0.03 Gm.). 

Therapeutics. — Novocain is a local anesthetic, possessing the 
same action on the peripheral nerves as cocain, with an equal 
amount of anesthetic potency. Applied locally, it has no side or 
after effects, and is nonirritating to the soft tissues. In conjunc- 
tion with adrenalin, it does not reduce the vaso-constrictor prop- 
erties of the latter ; on the contrary, it increases them to some ex- 
tent. The indications for novocain are the same as those for 
cocain. For hypodermic injections for dental purposes it is used 
in a 2-percent solution, with the addition of small quantities of 
adrenalin or synthetic suprarenin. (See Local Anesthesia.) To 
relieve painful conditions of wound surfaces or of a tooth socket, 
novocain, when placed or packed against such surfaces, will 
quickly relieve pain. 

Toxicology. — Novocain is about six times less poisonous than 
cocain. As much as 4 grains (0.26 Gm.) have been injected with 
no ill results. Liebl 1 injected in his own body 6 grains (0.4 
Gm.) of novocain, and an hour after the anesthetization had 
passed off he again injected 12 grains (0.8 Gm.) in a 10-percent 
solution. Slight intoxication followed, accompanied by optic dis- 
turbances, deafness, loss of energy, and headache. In one hour 
and a half all the symptoms had disappeared, without leaving any 
after effects. 



1 Liebl: Miinchener Medizinische Wochenschrift, 1906, No. 50. 



282 PHARMACO-THERAPEUTICS. 

Novocain intoxication presents very much the same symptoms 
as those produced by cocain, with this one important exception : 
its absolute toxicity is about six times less than that of cocain. 
Furthermore, it should be remembered that a definite synthetic 
product is always more reliable concerning its composition and 
chemic purity than an alkaloid from an animal or vegetable source. 

Local Anesthetic Solution. 

I£ Novocaini . gr. x (0.6 Gm.) 

Sodii chloridi gr. iv. (0.25 Gm.) 

Aquae destillat. fl^ j (30 Cc.) 

M. 

Sig. : To each cubic centimeter add 1 drop of adrenalin 
solution when used. 

Tropa-Cocain Hydrochloride It was discovered by Giesel, in 
1891, in the leaves of the Javanese coca plant. In 1902 Lieber- 
mann prepared it synthetically. It is very readily soluble in 
water, and its solutions may be boiled without decomposition, 
and they possess slight antiseptic properties. It is used in 2 to 
o-percent solutions; its anesthetizing power is less than that of 
cocain. Its action is quick, but of a short duration. If combined 
with adrenalin, it will almost completely destroy the vaso- 
constrictor power of the latter. 

Eucain A and. B. They are respectively the hydrochlorids of 
synthetic derivatives of triacetonamin and of vinyl-diacetonal- 
kamin. Eucain B is now exclusively used. It is a white crystal- 
line powder, soluble in 20 parts of water. Its solutions may be 
boiled without decomposition ; they are slightly antiseptic. It is 
about three and a half times less poisonous than cocain, but less 
active than the latter. When combined with adrenalin it partially 
destroys the vaso-constrictor power of the latter. 

Holocain Hydrochlorid. It is prepared by combining phena- 
cetin and phenetidin ; it is soluble in 40 parts of water, and easily 
decomposed by alkalies. Solutions may be sterilized by boiling. 
Holocain injections produce severe irritation. 

Acoin Hydrochlorid. It is a synthetic compound of the alkyl- 
oxyphenyl-guanidin group, and is related to holocain. It is a 



LOCAL ANESTHETICS AND OBTUNDENTS. 283 

white crystalline powder, soluble in 15 parts of water and very 
soluble in alcohol. Its solutions are readily decomposed by alka- 
lies ; they are very strongly antiseptic. It is a powerful local anes- 
thetic of lasting potency, but is much more poisonous than cocain. 
Its solution is strongly irritating to the tissues. 

Nirvanin. It is a synthetical product of the orthoform group, 
discovered by Einhorn in 1898. It is a white powder, readily 
soluble in water; it may be sterilized by boiling. It is employed 
in from 1 to 5-percent solutions; its injection is painful. While 
it is less toxic than cocain, its anesthetizing potency is also de- 
cidedly much less. 

Stovain. It is a derivative of the amino alcohol group. It was 
discovered by Fourneau in 1904, and introduced into materia 
medica by Billon. Rectus recommended it highly as a local anes- 
thetic. It is a crystalline white powder, readily soluble in water , 
with a distinct acid reaction, causing pain when injected, and 
possibly gangrene when employed in concentrated solution. Its 
solutions may be boiled ; they are slightly antiseptic. Stovain 
is about half as toxic as cocain, and may be used in V 2 to 1 per- 
cent solution. Combined with adrenalin it partially destroys the 
action of the latter. 

Alypin. Chemically it is closely related to stovain, being syn- 
thetically prepared from the same source. It is very readily solu- 
ble in water; its solutions may be boiled, and they react neutral 
to litmus paper. It is less toxic than cocain, and possesses about 
the same anesthetizing power, which is, however, of less duration. 
It is strongly irritating to the tissues, and in 5-percent solution 
may cause gangrene. In combination with adrenalin it will neu- 
tralize the vaso-constrictor power of the latter to some extent. 

Nervocidin. It is the hydrochlorid of an alkaloid obtained 
from an exotic plant of India known as Gasu-Basu, and introduced 
into materia medica by Dalma. It is a light-yellowish, very hygro- 
scopic powder, readily soluble in water. It can not be used for 
hypodermic injection, as it is very irritating. It is recommended 
for anesthetizing the dental pulp ; its mode of application for such 
purposes is similar to the one used for arsenic trioxid, and it de- 
serves to be tried in cases where arsenic is contraindicated. The 



284 PHARMACO-THERAPEUTICS. 

introduction of pressure anesthesia for the removal of the dental 
pulp has largely dispensed with the use of nervocidin. 

Chlorbutanol. It is also known as aceton-chloroform, chlore- 
tone, or in a 1-percent solution as aneson, or anesin. It is a tri- 
chlor-teitiary butyl alcohol, forming white crystals and having a 
camphoraceous odor. It is very soluble in chloroform, aceton, 
alcohol, and ether, and to the extent of less than 1 percent in 
water. Its solutions may be sterilized by boiling, and they possess 
antiseptic properties. Regarding its anesthetizing power, it is 
much weaker than cocain. 

Anesthetic Solution for the Dental Pulp. 

J$l Chloretoni 

Camphorae aa 5 ss (2.0 Gm.) 

01. cinnamomi gtt. x (0.6 Cc.) 

01. cajuputi 5 J (4 Cc. ) 

M. 

Sig. : Saturate a pledget of cotton and place on the aching 
pulp. 



Insoluble Local Anesthetics. 

A number of synthetic compounds have been introduced within 
recent years which possess marked analgesic power when applied 
in substance on painful mucous membranes or abraded surfaces. 
They are only slightly soluble in water and in the body fluids, 
and consequently they are not poisonous. Some of these com- 
pounds are slightly irritating to the soft tissues. They are usually 
prescribed in the form of dusting powders or ointments. 

Orthoform and Orthoform Neiv. Both are synthetic com- 
pounds prepared from aromatic amino-oxy-esters, forming grayish 
powders. They are antiseptic, insoluble in water, and conse- 
quently are slowly absorbed by the tissues; they are not used for 
hypodermic injections. They are beneficial for the relief of 
pain when placed on excoriated surfaces — as ulcers, burns, etc. — 
and deserve to be mentioned for the treatment of after pains 
arising from the extraction of teeth. As orthoform is irritating 
to the soft tissues, occasionally sloughing is observed after its too 



LOCAL ANESTHETICS AND OBTUNDENTS. 



285 



free use as a dusting powder. The ortho-forms are now largely 
supplanted by novocain. 

Anesthesin and Subcutin. Both chemicals are orthoform modi- 
fications. Anesthesin is insoluble in water, while its hydrochloric 
salt is soluble in water to the extent of 1 percent. The parasul- 
phonate of anesthesin is known as subcutin. Their solutions may 
be boiled; they react strongly acid, and consequently produce 
severe pain when injected hypodermically. 



Anesthetic Mixtures. 

aa 5 j (4.0 Gm.) 



$. Orthoformii 
Amyli 
M. 
Sig. : Dusting powder 



J$l Orthoformii 
Lanolini 
M. f. unguentum. 
Sig. : Orthoform ointment. 



3 j (4.0 Gm.) 
5 j (30.0 Gm.) 



The Chemic Relationship of the More Important Local 

Anesthetics. 

The basic chemic formula which furnishes the nucleus of a 
very large variety of important organic medicinal compounds is 
the benzol ring. 




By a complicated process of addition and substitution, a num- 
ber of bodies are produced which, in their physiologic action on 
sensory nerve tissues, resemble cocain — that is, they possess local 
anesthetic properties. Cocain, discovered by Nieman in 1859, is 
chemically a methyl-benzoyl-ester of ecgonin, C 17 H 21 N0 4 ; it is 
closely related to atropin and the tropins, or, rather, the pseudo- 



286 PHARMACO-THERAPEUTICS. 

tropins. Lossin, in 1865, had demonstrated that by decomposing 
cocain the following products were formed: Ecgonin, benzoic 
acid, and methyl alcohol. 

Ecgonin differs from pseudotropin only by having a carboxyl 
group present. In 1898 Willstatter definitely settled the chemic 
relationship between cocain and ecgonin by expressing their 
structural formulas : 

COCAIN. ECGONIN. 

CH2 CH— CH. COOCHs CH 2 CH CH. COOH 



NCHs GH.O.CO.CeH5 



NCHs CH.OH 



CH2 CH CH 2 CH2 CH CH 



Judging from these constitutional formulas, it seems that the 
required condition for the construction of a local anesthetic rests, 
a priori, on a base with a structure analogous to ecgonin, contain- 
ing a benzoyl and an alkyl radical in certain relations. A syn- 
thetic compound which is expected to be closely related in its 
physiologic action to cocain should therefore include in its for- 
mula the following basic groups : 

1. An element of nitrogen. 

2. A benzoyl group (the radical of benzoic acid), substituting 
the hydrogen of an OH group. 

3. The COOH group (alcohol radical). 

As an early substitute of cocain, tropa-cocain should be men- 
tioned. In 1891 Giesel isolated it from the coca leaves grown in 
Java, and Liebermann, in 1892, and Willstatter, in 1896, pre- 
pared it synthetically. Chemically, tropa-cocain is benzoyl pseu- 
dotropin ; its hydrochloric salt, C 15 H 19 N0 2 .HC1, is less poisonous 
than cocain, but has an almost equal potency. 

Meditating on the structural formulas of ecgonin and tropin, 
Merling, in 1896, conceived the idea that certain benzoyl deriva- 
tives which are closely related to tropin, like triacetonalkamin and 
vinyldiacetonalkamin, must also possess definite anesthetic prop- 
erties. On this supposition he prepared the methyl ester 1 of 



1 The combination of an organic acid with a phenol or an alcohol is known as an ester. 



LOCAL ANESTHETICS AND OBTUNDENTS. 287 

benzoyltriacetonalkaminocarbonic acid. This compound was 
later designated by Vinzi as eucain or eucain A, or alpha-eucain. 
Eucain A is very strongly irritating to the soft tissues ; to eliminate 
this factor, Vinzi slightly altered the structure of the formula, 
which resulted in the production of eucain B, or beta-eucain. 
benzoylvinyldiacetonalkamin hydrochloride C 15 H 21 2 N.HC1-|-H 20 . 

A year later, in 1897, Einhorn and Heinz showed that in these 
complex derivatives of the benzol ring the nitrogen molecule was 
not an absolute necessity for the production of local anesthetic 
effects; they found that almost all of the alkyl compounds of the 
esters of the amino acids and oxyamino acids possess very marked 
local anesthetic properties. The first body built on this suppo- 
sition in 1898 by the above named chemists is orthoform, the 
methyl ester of paraaminometaoxybenzoic acid (C c H 3 OH(NH 2 ) 
(COOH 3 )). It was followed by its modification, orthoform new. 
the methyl ester of metaminoparaoxybenzoic acid, which is pre- 
pared by simple reversion of the OH and the NH 2 groups. Both 
compounds dissolve with difficulty in water; they have a slight 
acid reaction, and, on account of the resultant irritation, are lim- 
ited in their uses. To further eliminate this side action of ortho- 
form, Einhorn and Heinz substituted glycocoll derivatives, and, 
in 1898, introduced a few compounds of this group which are 
known as nirvanin, holocain, and acoin. These compounds are 
comparatively valueless as anesthetics, and, on account of their 
more or less intense irritation, they have never been employed to 
any appreciable extent. 

The discovery of the orthoform group stimulated renewed ac- 
tivity for the further search of new local anesthetic bodies. Rit- 
sert, in 1901, eliminated the hydroxyl group from orthoform, and 
thus produced anesthesin, the ethyl ester of paraminobenzoic acid, 
an insoluble compound, which does not possess any advantage over 
orthoform. In preparing its p-phenolsulphonic acid salt, subcu- 
tin, a soluble and less irritating anesthetic is obtained. None of 
the various compounds so far mentioned have become meritorious 
substitutes of cocain ; they have never gained the confidence of 
the profession, and are at present largely abandoned. 

Fourneau, a French chemist, working under Fischer in the 



288 PHARMACO-THERAPEUTICS. 

Chemic Institute of the University of Berlin, perpared in 1904 a 
chain of compounds in which he incorporated the alcohol radical 
with the nitrogen atom of the original benzol ring. The most 
effective of these compounds is known as stovain, dimethylamino- 
benzoylpentanol hydrochloride C 14 H 21 N0 2 .HCL Stovain, 1 being 
readily soluble in water, reacts strongly acid, and .therefore irri- 
tates to a considerable extent the soft tissues. To further modify 
this acid property, Impens, in 1905, added a dimethylamino 
group to the second methyl group, thus creating a neutral body 
known as alypin, C 12 H 26 N0 2 . HC1, benzoyltetramethyldiamino- 
ethylisopropylalcohol hydrochlorid, which, however, is still irri- 
tating to the tissues. 

From the extensive experimental work conducted by the various 
investigators it becomes very convincing that the search for a local, 
anesthetic which would possess all the good qualities of cocain, 
without its poisonous effects or any irritating side action, must be 
looked for in the salts of the alkaminesters of the aminobenzoic 
acid — that is, the modified orthoform group. Einhorn and Uhl- 
f elder again returned to anesthesin, taking it as a base for their 
synthetic research, and, after producing some 400 odd variations, 
finally, in 1905, succeeded in preparing the hydrochloric salt of 
paraamidobenzoyldiethylaminoethanol, C00.C 2 N 4 (C 2 H 5 ) 2.NH 2 . 
HC1, a diethylamino derivative of anesthesin, which they termed 
novocain. Of all the synthetic substitutes of cocain so far offered 
to the profession, novocain seems to answer the demands better 
than any other known compound. 

In comparing the structural relationship of some of the modern 
local anesthetics, it is interesting to observe that the base of the 
orthoform groups and eugenol resemble each other closely. Euge- 
nol, paraoxymetamethoxyallyl benzol, C 10 H 12 O 2 , or C 6 H 3 (OH) 
(OOH 3 ).(CH 2 .CPI:CH 2 ) (4:3:1), is the principal active constitu- 
ent of oil of cloves; it is also found in many other essential oils. 
Oil of cloves enjoys an old and much lauded reputation as an 
effective toothache remedy, which it owes solely to the presence of 
eugenol. Eugenol, while being strongly anesthetic, is also slightly 



1 Fourneau translated his name into English— stove— and from this word created the word 
stovain. 



LOCAL ANESTHETICS AND OBTUNDENTS. 289 

caustic. To eliminate this caustic action, the p-aminobenzoic acid 
was isolated, which, however, proved wholly inactive. The ethyl 
ester of this acid, as we have seen, forms anesthesin, and the 
hydrochlorid of this diethylaminoethanol ester is known as novo- 
cain. Both anesthetics may be commercially prepared from the 

oil of cloves. 

- 

Refrigerant Local Anesthetics. 

Refrigerant anesthetics are local applications which abstract 
heat from the tissues. They lower the temperature, diminish sen- 
sation, and reduce the volume of the parts to which they are ap- 
plied. Their continuous application produces in due time definite 
anesthesia. The application of freezing agents should be restricted 
to small areas. 

Ether; .Ether, U. S. P., B. P.; (C 2 H s ) 2 0. 

Pure ethyl ether of at least 95 percent is essential to obtain good 
results. Freezing and the subsequent anesthesia of the tissues is 
only slowly produced by ether. Special apparatus are necessary 
for the ready dessemination of the ether vapors ; those of Richard- 
son and of Lasser are especially adapted for the teeth. To obtain 
good results, the ether spray should be brought in close contact 
with the tissues. The tissues become intensely red and then white ; 
the latter color indicates complete anesthesia. The vapors of ether 
are very inflammatory ; even the . spark from an electric light 
switch has caused an explosion of ether vapors in an operating 
room. Ether is rarely used at present for local anesthetic pur- 
poses in dentistry. 

Ethyl Chlorid; ^thylis Chloridum, U. S. P.; C 2 H 5 C1; Anti- 
dolorine; Kelene; Narcotile. 

A colorless, mobile, very volatile fluid, having an agreeable odor 
and burning taste. On account of its extreme volatility it is best 
preserved in hermetically sealed glass or metallic tubes, and kept 
in a cool place, removed from light and fire. It boils at about 
55° F. (12.8° C). Ethyl chlorid produces a satisfactory local 



290 PHARMACO-THERAPEUTICS. 

anesthesia by freezing, and is probably the best agent used for 
such work. (See Local Anesthetics.) 

Methylchlorid ; Methylis Chloridum; CH 3 C1. 

A colorless, mobile, and very volatile fluid, having a rather 
agreeable odor. It boils at — 12° F. ( — 24.5° C), and must be 
kept in strong metallic cylinders. The methyl chlorid spray pro- 
duces a very quick and intense freezing of the tissues, frequently 
resulting in gangrene; for this reason it is seldom applied in its 
pure state in dentistry at present. To modify the severe action 
of methyl chlorid, it is mixed with ethyl chlorid in various pro- 
portions, and is known as coryl. A mixture of equal parts of 
methyl and ethyl chlorid is known as anesthile (Bengue), anestol 
(Speier), and as methethyl (Henning) ; the latter is a mixture of 
methyl chlorid, ethyl chlorid, and chloroform. 

Local anesthesia by means of refrigerant agents is much less 
employed at present than in former years. The general applica- 
bility and comparative safety of local anesthesia by cocain or its 
^substitutes have almost completely superseded the freezing method, 
which, at best, is a rude method of subduing pain. 

Other Local Anesthetics. 

Phenol enjoys quite a reputation as a local anesthetic, especially 
in dental surgery. As it is very strongly irritating, and even caus- 
tic if applied in solutions sufficiently concentrated to cause local 
anesthesia, it is prone to produce phenol (carbolic acid) necrosis. 
Guaiacol, which is closely related to phenol, possesses also slightly 
anesthetic properties; when injected it produces necrosis. Kava- 
kava, a resin prepared from roots of Piper methysticum, possesses 
pronounced anesthetic properties; it is too irritating to be used 
for injection. Yohimbin, an alkaloid of the yohimbe bark, acts 
as an anesthetic if injected as a 1-percent solution; it possesses 
pronounced virtues in the treatment of certain forms of impo- 
tence. Quite a number of other drugs possess local anesthetic ac- 
tion — menthol, chloroform, aconite, etc. — and are all more or less 
frequently employed externally in the form of liniments, oint- 
ments, etc. Merely to complete the list, a few more of the recent 



LOCAL ANESTHETICS AND OBTUNDENTS. 291 

additions to the long list of local anesthetics may be named — adon- 
idin, convallamarin, dionin, helleborin, peronin, and vanillic acid. 
Carbonic acid in the form of soda water or champagne deserves 
to be mentioned as a prompt anesthetic of the stomach in case of 
nausea. Very recently it has been observed that, in treating 
malaria with hypodermic injections of quinin and urea hydrochlo- 
rid (carbamidated quinin dihydrochlorid) , local anesthesia in the 
injected area is produced. Based on this observation, the quinin 
compound has been recommended as a substitute for cocain, 
novocain, and the other local anesthetics. From a careful in- 
quiry into its pharmacologic action 1 we are forced to conclude 
that quinin and urea hydrochlorid, when employed as a local 
anesthetic in dental operations, possesses no advantages but many 
disadvantages as compared to cocain, novocain, etc. While, 
a priori, its non-poisonous nature indicates safety, this safety is 
only relative, as it refers to larger doses. The solution of quinin 
and urea hydrochlorid reacts strongly acid, and as a consequence 
severely damages the tissues within the injected area. Indura- 
tion and edema are the usual sequelae. Its injection is more or 
less painful, and it interferes with the progress of wound-healing. 
When applied to mucous surfaces in the mouth, even in concen- 
trated solution, it is only sparingly absorbed, and consequently 
very little, if any, local anesthesia is produced. Aside from this 
defect, its most persistent very bitter taste makes it undesirable 
for this purpose. 

Quinin and urea hydrochlorid is readily soluble in water; its 
solution can be sterilized by boiling without alteration, but readily 
decomposes on standing. The solution is tolerant to the addition 
of ordinary doses of adrenalin without interfering with the vasco- 
constrictor power of the latter. 

Redard, 2 of Geneva, in 1904 introduced the use of blue light 
as a local anesthetic. Apparently the anesthesia obtained with this 
light is a form of analgesia, which in all probability is as much due 
to suggestion as to the blue light itself. Since Redard's publica- 
tion appeared nothing further of importance has been published. 
Anesthetization by blue light has never become popular. 



1 Prinz: Dental Cosmos, 1911, p. 31. 

2 Redard: Ash's Quarterly Circular, 1904, p. C05. 



292 PHARMACO-THERAPEUTICS. 

GENERAL ANESTHETICS. 

Anesthetics (without sensation), sometimes referred to as nar- 
cotics (loss of sensation and consciousness), are, in a restricted 
sense of the term, substances which, when inhaled into the lungs, 
act on the central nervous system and cause an artificial depriva- 
tion of all sensation. The principal anesthetics employed for 
dental purposes are nitrous oxid, ethyl bromid, ethyl chlorid, 
ether, chloroform, etc., and various mixtures of these and other 
substances. 

The discovery of general anesthesia is so closely interwoven with 
the evolution of dentistry in the United States that it is impossible 
to mention the one without referring to the other. The blessings 
of anesthesia to suffering humanity can not be overestimated, and 
what Liecky has written is certainly true: "It is probable that 
the American inventor of the first anesthetic has done more for the 
general happiness of mankind than all the moral philosophers." 
It is not our intention to present at this moment a detailed account 
of this most important occurrence, and we wish merely to refer to 
a few incidents which may facilitate a clearer comprehension of 
the matter under consideration. 1 

According to more recent investigations, it is probably a set- 
tled fact that nitrous oxid was discovered by Joseph Priestly in 
1772, who gave it the name "dephlogisticated nitrous air." 2 In 
the succeeding years he referred to the substance quite frequently, 
and it soon aroused general interest, becoming an important sub- 
ject for discussion in the learned societies. The big lecture hall of 
the Royal Institute of England was frequently the scene of public 
demonstrations of the physiologic effects of the "dephlogisticated 
nitrous air," at which Count Rumford, Davy, and other notables of 
the time were usually present. A peculiar accident which occurred 
at one of these meetings gave inspiration to Gilray for his carica- 



1 Excellent accounts of the much discussed subject of the discovery of anesthesia are found 
in the following works: Nevius: Discovery of Modern Anesthesia, 1894; McManus: Notes on the 
History of Anesthesia and the Wells Memorial Celebration, 1896; Hewitt: Anesthetics and 
Their Administration, 1907. The many works on general anesthesia usually furnish more or 
less extended records on this subject. 

2 Cohen: Das Lachgas, 1907. 



GENERAL ANESTHETICS. 293 

ture, which at the time very much amused the learned men of 
England. 

The preparation of nitrous oxid from ammonium nitrate is to 
be credited to the celebrated astronomer Laplace. Sir Humphrey 
Davy conducted careful investigations of this much discussed sub- 
stance, and soon became acquainted with the exhilarating influence 
which it exercised on himself and on some of his friends. His 
experiments were published in 1800. 1 It is interesting to observe 
that Davy made various allusions to the physiologic action of this 
gas. He states that "the effects of nitrous oxid on different indi- 
viduals and on the same individual at different times proved that 
its powers are capable of being modified, both by the peculiar con- 
ditions of organs and by the state of the general feeling." He 
recognized its possible use as an anesthetic, for he says that "it may 
probably be used to advantage during surgical operations in which 
no great effusion of blood takes place," a prophecy which required 
nearly half a century to become true. But not alone was its 
anesthetic effect recognized by him, but he also pointed out its 
comparatively safe administration by saying: "Modifications of 
the powers of nitrous oxid by mixtures of gas with oxygen or com- 
mon air will probably enable the most delicately sensible to respire 
it without danger, and even with pleasurable effects." 

Demonstrations of the exhilarating effects of nitrous oxid were 
a prolific source of public entertainments in England in the years 
following its discovery, and in due time found their way into the 
United States. It was at one of these demonstrations that the con- 
ception of its utilization for the purpose of producing insensibility 
to pain was conceived by a dentist. This conception and its suc- 
cessful application marked the birthday of anesthesia. The inci- 
dent is recorded as follows: 2 



1 Davy: Researches on Nitrous Oxid, 1800. 

" Not in the ideal dreams of wild desire 

Have I beheld a rapture-wakening form: 
My bosom burns with unhallowed fire, 

Yet is my cheek with rosy blushes warm; 
Yet are my eyes with sparkling luster fill'd; 

Yet is my mouth replete with murmuring sound; 
Yet are my limbs with inward transports fill'd, 

And clad with new-born mightiness around." 

2 A History of Dental and Oral Science in America, prepared under the direction of the 
American Academy of Dental Science, 1876. 



294 PHARMACO-THERAPEUTICS. 

"On the evening of December 10, 1844, Dr. Horace Wells, a practicing 
dentist of Hartford, Conn., attended in that city a chemical lecture by Mr. 
G. Q. Colton, during or after which the lecturer administered to Mr. Samuel 
A. Cooley and others the nitrous oxid gas. Mr. Cooley, on being brought 
under its influence, became unusually excited, and, during his consequent 
activity, sustained severe bruises, of which fact he was unconscious until 
after recovery from the effects of the gas. His asseverations of want of 
knowledge of any pain while in the unconscious condition took strong hold 
on the mind of Dr. Wells, and he immediately expressed his belief that 
teeth could be painlessly extracted during the inhalation of this agent. So 
strongly was he thus impressed that the next day he requested Mr. Colton 
to provide some of the gas for him, which he took himself, holding the bag 
in his lap, and while under its influence underwent the extraction of a molar 
tooth at the hands of Dr. John M. Riggs, a fellow-dentist of Hartford. 
Upon his recovery Wells exclaimed in high glee, 'A new era in tooth pull- 
ing!' The exclamation was prophetic. So elated were Drs. Wells and 
Riggs at the success of their experiment that they immediately turned their 
attention to the extraction of teeth by the aid of this agent, and continued 
to devote themselves, in conjunction, to this subject for several weeks 
almost exclusively. Dr. Wells used the gas freely during the whole time 
of his dental practice, and Dr. Riggs employed it constantly 'as people 
demanded it, which they ordinarily did,' until 1847, when he began to 
employ chloroform in its stead. Wells, however, was not content to dem- 
onstrate the availability of nitrous oxid as an anesthetic in dentistry alone, 
but carried it into general surgery. The first recorded case of this char- 
acter occurred on August 17, 1847, being the extirpation of a large scirrhous 
growth by E. E. Marcy, M.D., then of Hartford. The case is reported at 
length in the Boston Medical and Surgical Journal, September 1, 1847. 
The gas was administered by Dr. Wells, and its operation was entirely satis- 
factory. The second case was amputation of the thigh, occurring January 
1, 1848; the operator, Dr. P. W. Ellsworth, and the gas given by Dr. Wells. 
This case is also reported in the above periodical, Vol. XXVII, p. 498. The 
last we shall mention was the removal of a fatty tumor from the shoulder 
at Hartford, January 4, 1848; S. B. Beresford, M.D., the operator, and the 
gas given, as before, by Horace Wells. This was only twenty days before 
Wells' death. Almost immediately upon Wells' discovery the use of the 
gas became quite general with the Hartford dentists. John B. Terry (after- 
ward Dr. Wells' associate in practice), John Braddock, and E. E. Crowfoot, 
all dentists of that city, used the agent between the time when Wells 
brought it to notice and September 30, 1846, a date which will be presently 
noticed in connection with the subject of ether. A short time after his 
discovery, Dr. Wells visited Boston in order to bring it before the medical 
men of that city. Calling on Professor Warren, of the Harvard Medical 
College, he communicated the facts to him, and was referred to the students 
for examination, before whom he administered the gas to a patient who 
desired a tooth drawn; but, probably from the bag containing the agent 
being withdrawn too soon, the patient made some noise during the opera- 
tion, although he afterward asserted that he had not felt pain. From this 
unfortunate circumstance the majority present thought the experiment a 



GENERAL ANESTHETICS. 295 

failure, though many considered that complete anesthesia had been pro- 
duced, and afterward made oath or published statements to that effect. Of 
these may be mentioned Wm. M. Cornell, Mason M. Miles, and C. A. Taft. 
While in Boston at this time, and previous to his experiment at the Harvard 
school, Dr. Wells called on Dr. Charles T. Jackson and Dr. Wm. T. G. 
Morton, the latter an old pupil and partner of his, and communicated his 
discovery to them. This, it will be remembered, occurred in December, 
1844. These gentlemen ' expressed themselves in the disbelief that surgical 
operations could be performed without pain, both admitting that the modus 
operandi was entirely new to them. ' The fact of this visit, at the date 
and for the purpose alleged, is admitted by Morton in his subsequent 
memoir to the French Academy of Arts and Sciences on the subject of the 
discovery of the anesthetic effects of sulphuric ether. After the discovery 
was made, Wells had frequent interviews with Morton on the subject, and 
the latter requested instructions in the preparation of the gas, as he wished 
to try it in Boston. Probably aware of the danger, to a nonchemist, of 
preparing the nitric oxid in place of the nitrous oxid, Wells advised Morton 
to go to Dr. Jackson in Boston, who was a chemist and could prepare the 
gas properly. This fact is susceptible of abundant proof." 

Ether was discovered in the middle of the sixteenth century by 
Cordus, but it remained for two American physicians and two 
American dentists to introduce it as a general anesthetic between 
1842 and 1846. Crawford W. Long, M. D. ; Charles T. Jackson, 
M. D., and the dentists, Horace Wells and William T. G. Morton, 
are the four claimants for this honor. Long used ether as a gen- 
eral anesthetic as early as 1842, but, living in a little, obscure 
country place in Georgia, and not having made public his ex- 
periences with this anesthetic, the discovery remained unknown to 
the world at large. The first publication by Long regarding the 
use of ether appeared in December, 1847. 1 Without knowledge of 
Long's discovery, Morton introduced ether in Boston in 1846 as 
"Letheon" — ether mixed with essential oils to disguise its odor. 
The ether was prepared for him by Jackson. Wells, however, who 
was experimenting with nitrous oxid and other anesthetic sub- 
stances two years prior to Morton's discovery, administered ether 
as an anesthetic in 1845. Wells received the suggestion of using 
ether for such purposes from E. E. Marcy, M. D., of Hartford, 
Conn., in 1844. It is not our intention to make an attempt to 
settle the rights of priority regarding the introduction of ether as a 



1 Long: An Account of the First Use of Sulphuric Ether by Inhalation as an Anesthetic in 
Surgical Operations, Southern Medical and Surgical Journal, 1849. 



296 PHARMACO-THERAPEUTICS. 

general anesthetic; volumes have been written about the con- 
troversy between the various claimants. Let it suffice to say that 
the above-named gentlemen shared a more or less equal right in 
this great discovery. 

Chloroform was discovered at about the same time (1831-32) 
by Samuel Guthrie, of Sackett's Harbor, N. Y. ; by Liebig, of Ger- 
many, and by Soubeiran, of France. It was introduced as a gen- 
eral anesthetic by Simpson, who in 1847 published a lengthy 
report concerning its superiority over ether as observed by him in 
the clinics of Edinburgh University. 

Ethyl chlorid was discovered in 1759 by Bouelle. In 1848 it 
was introduced as a general anesthetic by Heyfelder. The high 
price of ethyl chlorid and the difficulty of obtaining a pure product 
prevented its ready adoption as an anesthetic. In 1867 Rotten- 
stein called attention to the use of ethyl chlorid as a refrigerant 
agent for local anesthetic purposes, and in 1889 Rhein suggested 
methyl chlorid for the same purpose. In 1891 ethyl chlorid was 
reintroduced as a refrigerant agent by Redard, and in 1895 Carl- 
son observed two cases of general anesthesia resulting from inhal- 
ing its vapors when employed locally in the mouth. Thiesing, in 
1896, again experimented with this agent in regard to its general 
anesthetic properties, and in the same year Lotheisen, Ludwig, and 
Pischer, followed in short succession by Billeter, Ruegg, Respinger, 
Seitz, Brodtbeck, and others, introduced it again in general and 
dental surgery. Ethyl chlorid forms the base of many mixtures 
which are used as local refrigerants and general anesthetics, of 
which somnoform, introduced by Roland in 1902, is probably the 
best known type. 

Nitrous Oxid; Nitrogenii Monoxidum; N 2 0. 

Synonyms. — Nitrogen monoxid, nitrogen protoxid, laughing 
gas, dephlogisticated nitrous air; protoxyde d'azote, F. ; Stick- 
stoffoxydul, Lachgas, G. 

Source and Character. — Nitrous oxid was first obtained by 
Priestly, in 1772, by the action of nitric acid on moist iron filings. 
Laplace and, later, Berthollet prepared the gas from ammonium 
nitrate, and Deiman and Troostweijk, in 1773, determined its com- 



_ 



GENERAL ANESTHETICS. 



297 



position. Davy, in 1800, observed its exhilarating effects and 
referred to its probable vise as a general anesthetic. Nitrous oxid 
is usually prepared from ammonium nitrate, which should be free 
from chlorids, by gradual decomposition by heat. At present a 
mixture of dried sodium or potassium nitrate and dried ammonium 
sulphate is also employed; it is said that the preparation of the gas 
from this mixture is free from danger. Tn preparing the gas the 
dry ammonium nitrate is placed in a spacious glass or porcelain- 
lined iron retort, connected with a series of wash bottles and the 
storage tank of a gasometer, and heat is applied. The ammonium 




H 2 SO< 



KOH 



FeS0 4 
Figure 25. 



Apparatus for Making: Nitrous Oxid. A Lennox porcelain-lined iron retort is connected with 
a series of wash bottles, ready for use. The last wash bottle is connected with the storage tank. 



nitrate decomposes at about 392° F. (200° C.) ; the heat should 
never be carried above 405° F. (240° C), to prevent the 
formation of poisonous nitric oxid and nitrogen. The decomposi- 
tion of ammonium nitrate into water and nitrous oxid takes place 
according to the equation : 

NII 4 N0 3 =2H 2 0+N 2 0. 

The wash bottles contain respectively solutions of ferrous sul- 
phate, potassium hydroxid, and a weak solution of sulphuric acid 
or milk of lime for the purpose of removing impurities — chlorin, 
nitric oxid. ammonia, etc. — from the gas and to dry it. One pound 



298 PHARMACO-THERAPEUTICS. 

of ammonium nitrate will approximately yield thirty-two gallons 
of nitrous oxid gas (500 grams yield about 140 liters). 

Nitrous oxid is a colorless, elastic gas, having a very slightly 
agreeable odor and a sweetish taste. It has a specific gravity of 1.6 
(Dalton), and a gallon of it weighs approximately 1 / 4 ounce 
(1 liter weighs about 2 grams). At 30° F. (0° C.) and under a 
pressure of 50 atmospheres it is liquefied into a stable, colorless, 
very mobile fluid; at —148° F. (—100° C.) it solidifies into color- 
less crystals. Liquefied nitrous oxid boils at about —126° F. 
( — 88° C). The gas is fairly soluble in water, alcohol, ether, and 
volatile and fixed oils. Nitrous oxid supports combustion in the 
presence of oxygen, but it does not support life. Unless nitrous 
oxid is used in large quantities, at present its preparation is not 
undertaken by the general practitioner in his office. It is now 
usually obtained from the dental depots in liquid form, stored in- 
steel cylinders, which contain respectively 100,' 250, and 400 gal- 
lons. These cylinders are painted black to differentiate them from 
the cylinders containing liquid oxygen, which are painted red. 

Physiologic Action of Nitrous Oxid. 

As stated, nitrous oxid supports combustion in " the presence of 
air, but it does not support life. Plants will not grow in an atmos- 
phere of pure nitrous oxid gas, nor will seed germinate. N 2 is an 
inorganic compound ; it will not decompose in the lungs, and will 
not enter into chemic combination with the blood, but is readily 
mechanically absorbed by the latter without entering into a true 
solution and without affecting its hemoglobin. When the further 
supply of N 2 is discontinued, the inner pressure of the gas in the 
lungs is released, and the blood quickly gives up N 2 0, replacing it 
with normal air. When an animal is exposed to an atmosphere of 
nitrous oxid, the metabolism of the tissue cells is inhibited in 
exactly the same manner as by the presence of any other indif- 
ferent gas which may have taken the place of oxygen, and the 
animal finally dies from asphyxiation. The asphyxiating factor 
has been denied by Luke 1 and by others. Wood 2 has, however, 



1 Luke: Guide to Anesthetics, 1906. 

2 Wood: Dental Cosmos, 1893. 



GENERAL ANESTHETICS. 299 

clearly demonstrated that the action of N 2 on the blood is largely 
of an asphyxiating character, as even so slight an admixture as 
3 parts of oxygen will delay anesthesia to quite an extent. Nitrous 
oxid gas apparently exercises some definite influence on the central 
nervous system, especially the centers of respiration, and to a less 
extent on those of the circulation. The depression of the respiratory 
centers is the more pronounced factor. Death from N 2 poisoning 
results from an inhibition of the functions of these centers, com- 
bined with asphyxiation. The various functions of the organism 
under N 2 narcosis are impaired in the same routine order as 
results' from any other general anesthetic — the cerebrum, the 
cerebellum, the medulla oblongata, and finally the ganglia in the 
heart. The early manifestation of cyanosis indicates the want of 
oxygen and the irritation of the respiratory centers in the medulla, 
which is caused by the accumulated C0 2 . It is further stated that 
N 2 produces irritation of the nerve centers controlling the genito- 
urinary apparatus. The high pressure which is induced by nitrous 
oxid anesthesia is said to be dangerous in feeble, elderly people, 
but so far no proof has been brought forward to substantiate such 
statement. 

Administration of Nitrous Oxid. 

Before starting anesthetization the anesthetist should comply in 
all cases with a fixed set of rules. A third person, preferably a 
woman, should always be present when a general anesthetic is 
given, and should remain in the room until the patient has recov- 
ered full consciousness. The patient is seated in a rigidly adjusted 
low dental chair, or in an easy chair with a high back. The 
patient assumes an easy position, and the head is placed so as to be 
in the same long axis with the spinal column. His clothing must 
be loosened, especially about the neck and the waist, to insure free 
and easy breathing. The mouth is inspected for removable den- 
tures, chewing gum, tobacco, etc., and a suitable mouth prop is now 
selected. Various sizes and shapes of props are available ; they are 
made of cork, wood, soft rubber, etc., and these are preferable to 
metallic props. Props made of soft pine wood, which are dis- 
carded after being used but once, are at present in favor with pro- 



300 



PHARMACO-THERAPEUTICS. 



fessional anesthetists. 1 Hinged metallic props, working on the 
principle of a mouth gag, are sometimes of service, especially when 
teeth on both sides of the jaws are to be removed. The Lawrenz 
prop is especially serviceable for such purposes. The prop should 









Figure 26. 
Soft Wood Mouth Props 



always be secured with a stout cord to prevent swallowing in case 
of accident. The anesthetic apparatus, especially the valves and 
other necessary requisites needed for the operation, must be in per- 
fect working order. Sufficient gas should always be on hand to 
complete the operation. The gas is turned on, and a little is passed 
through the bags and tubes to expel the air. After having put the 





Figure 27. 
Semi-Solid Rubber Bite Blocks. 



mouth prop in position, the face hood or inhaler is carefully 
adjusted. A few breaths of air are now admitted, and then the gas 
is allowed to be freely inhaled. The amount of nitrous oxid gas 
necessary for a single administration varies; an average of five to 



1 The writer is indebted to Dr. George B. Winter, of St. Louis, for samples of these props as 
used by the Doctor in his practice. 



GENERAL ANESTHETICS. 301 

twelve gallons are needed for a complete anesthetization, although 
sometimes very much larger quantities are required. Complete 
anesthesia manifests itself by deep and stertorous breathing and by 
pronounced cyanosis of the lips. Chronic muscular spasms of the 
limbs — jactitation — are often observed. The pupils are dilated, 
and the conjunctival reflexes are abolished ; the eye balls are often 
turned upward and then become fixed. The pulse is full and 
bounding. The average anesthesia lasts about forty-five seconds, 




Figure 28. 
Lawrenz Adjustable Mouth Prop. 

and the patient usually recovers very quickly. The after effects of 
nitrous oxid are very slight; occasionally vertigo, slight nausea, 
and a mild form of headache are experienced. 

The various apparatus used for the administration of nitrous 
oxid differ greatly. The operator who prefers to make his own gas, 
stores it in a gasometer holding a hundred or more gallons, while, 
when liquefied N 2 is used, the smaller gasometer, gauged to ten- 
gallon capacity, is usually employed. The inner construction of 
the gasometer is readily understood by examining Figure 30. The 



302 



PHARMACO-THERAPEUTICS. 



bell or gas tank must be accurately balanced so as to give an even 
pressure to the gas. Most of the modern apparatus for N 2 
anesthesia have discarded the tank ; they carry the soft rubber bag 
as a pressure chamber for the liberated gas. From the bag the gas 
passes directly into the inhaler, or, if it is administered in con- 




FlGURE 29. 

Nitrous Oxid Gasometer. 



junction with oxygen, through a mixing chamber. The modern 
gas tanks are usually of a portable nature, and the many different 
makes leave a wide choice for suitable selection of the proper ap- 
paratus. In England the Hewitt outfit and the Lennox-Coleman 
combination outfit are preferred by the profession. In purchasing 



^1 



GENERAL ANESTHETICS. 



303 



an English outfit it should be remembered that the English gas 
cylinders do not fit the domestic yoke connection, and that they 
can not be refilled in the United States. Most English apparatus 



w Art vr tt#£) 




to if a » »*ii*9l»y 



Figure 30. 
Nitrous Oxid Gasometer. Sectional view. 



have the bag directly connected with the face piece, except in the 
Lennox-Coleman-Patterson types; in the latter combination the 
bag is attached midway between the cylinders and the face piece. 
Modern American gas stands have the bag fastened to the upright 



304 



PHARMACO-THERAPEUTICS. 




Figure 81. 

Universal Gas Stand for Nitrous Oxid. 



GENERAL ANESTHETICS. 



305 



of the stand, or complete portable apparatus, arranged in con- 
venient surgeon's bags, may now be obtained. It is quite unneces- 
sary, for our present consideration, to enter into a detailed descrip- 
tion of the working methods of the various apparatus. A clear con- 
ception of their construction is readily obtained by examining the 
accompanying illustrations of the more generally used outfits. 
The gas is conveyed to the respiratory apparatus by various 




Figure 32. 

Surgeon's Portable Nitrous Oxid Apparatus. 

forms of inhalers, known as a face piece when covering the 
mouth and the nose, as a mouth piece when inserted between the 
lips, and as a nasal inhaler when held before the nose or inserted 
into the nostrils. Again, it is a matter of choice of the operator 
which inhaler is best suited for his purpose. The ordinary face 
piece is usually made of soft rubber, with a plain rim or an in- 
flatable cushion. Recently celluloid face hoods, supplied with an 
inflatable rim, have become great favorites. The Ash or the S. S. 



306 



PHARMACO-THERAPEUTICS. 




Figure 33. 

Universal Gas Stand. A combination of nitrous oxid and oxygen cylinders, gas bags, gauge 
plate and mixing chamber. 



GENERAL ANESTHETICS. 



307 



White celluloid hood and the Strangways aseptic inhaler are excel- 
lent types of this important adjunct to the N 2 apparatus. Of 
the many nose inhalers the Teter and Coleman types answer the 
purpose well; the Coleman improved nasal inhaler is principally 
employed in England. The Thomas or the Simplex inhaler are 




Figure 34. 

Coleman's Nasal Inhaler, Connected. A, nose piece disconnected; B, nose piece secured to 
the metal connections and rubber conveying pipes; C, sliding: clamp; D, stopcock; E, mouth 
cover; F, gas bag; G, rubber tubing leading to the union on the gas cylinders. 

good types of mouth pieces, and can be recommended to those who 
prefer this method of administering gas 

Prolonged anesthesia by means of a mixture of nitrous oxid and 
oxygen has been introduced within recent years for the purpose of 
increasing the anesthetic period of pure nitrous oxid. Bert, in 



S08 



PHARMACO-THERAPEUTICS. 




Figure 35. 

Teter Combination Gas Stand. For the administration of nitrous oxid and oxygen, and pro- 
vided with chloroform or ether attachment. 



GENERAL ANESTHETICS. 



309 



1878, suggested a method of increasing the length of anesthesia by 
administering N 2 under pressure. Owing to the cumbersome 
apparatus required, it was never put to practical use. Later he 
experimented with a mixture of 80 percent of nitrous oxid and 20 
percent of oxygen, and reported that complete anesthetization 
could be readily accomplished by this mixture. Bert's suggestion 




Figure 36. 
Nitrous Oxid Inhaler, with Celluloid Hood. 



was followed by Martin, Hillischer, Witzel, Wood, Hewitt, and 
others. Hewitt finally devised a perfect working apparatus, and 
his method, with slight modifications, is the one which is uni- 
versally employed at present. In the beginning of the narcosis 
pure N 2 is preferably administered, and only after full anestheti- 
zation is obtained oxygen is added for continuing the anesthesia. 
During the administration of a mixture of nitrous oxid and 



310 



PHARMACO-THERAPEUTICS 




Figure 37. 
Teter Nasal Inhaler. 




Figure 38. 
Simplex Inhaler. Sectional view. 



GENERAL ANESTHETICS. 311 

oxygen the pulse is usually slightly quicker than it was immedi 
ately before the anesthetic was given, and it remains at this rate 
during the entire narcosis. The eyes are in most cases closed; by 
raising the eyelid after complete anesthetization it will be noticed 
that the conjunctiva] reflexes are abolished. The pupils are 
usually of riorrnal size, or they may become slightly dilated. The 
anesthetized patient should present the picture of one being asleep, 
characterized by "a softly snoring breathing, a good pulse, a color 




Figure 39. 

Brown Anesthetize)-. Ready for administration. 

as near the normal as possible, an insensitive ocular conjunctiva, 
relaxed eyelids, a fixed condition of (he globes, and the absence 
of muscular rigidity in the extremities. Sometimes, and espe- 
cially after a phase of rapid breathing, or when a good deal of 
oxygen has been given, the respiration may come almost or com- 
pletely to a standstill without there being the slightest need for 
alarm. The apneic state is associated with a good pulse and 



312 



PHARMACO-THERAPEUTICS. 



color, and will quickly pass off when the proportion of oxygen 
is reduced/' (Hewitt.) 1 

It is quite difficult to state the exact amount of oxygen which can 
be safely mixed with nitrous oxid without disturbing the complete 
narcosis; the individuality of the patient is the correct guide. An 
average of 5 to 9 percent of oxygen is found sufficient for carrying 




Figure 40. 
Brown Anesthetizer. A nitrous oxid and oxygen combination utfit. 



on a prolonged anesthetization for an hour or more. Disagreeable 
side or after effects are rarely met in this mixed form of anesthesia, 
and, relatively speaking, the N 2 0-|-0 mixture is by far the safest 
of all known anesthetics. 



1 Hewitt: The Administration of Nitron. Oxid and Oxygen for Dental Operations, 1897. 



GENERAL ANESTHETICS. 313 

Chloroform; Chloroform, U. S. P., B. P.; CHC1 3 ; Trichloro- 

METHAN ; CHLOROFORME, F. ; CHLOROFORM, G. 

Source and Character. — Chloroform is a liquid, consisting of 
99 percent by weight of absolute chloroform and 1 percent of 
water. It should be kept in dark-colored bottles and in a cool, dark 
place. At present it is usually prepared by distilling a mixture 
of chlorinated lime and water with alcohol or acetone. It is a 
heavy, clear, mobile, and diffusible liquid, having a characteristic, 
ethereal odor and a burning taste. It has a specific gravity of 
1.475, and is soluble in all proportions in alcohol, ether, petroleum, 
benzin, and in fixed and volatile oils. When agitated with water, 
it is soluble in about 200 parts of the latter. Chloroform is readily 
volatilized, and boils at 140° F. (66° C). It is not inflammable, 
but its vapors burn with a green flame. 

Average Dose. — 5 minims (0.3 Cc). 

Ether; ^Ether, U. S. P., B. P.; (C 2 H 5 ) 2 0; Sulphuric Ether; 
Ether Sulphurique, F. ; Schwefelather, G. 

Source and Character. — It is a liquid, composed of about 96 
percent by weight of absolute ether (ethyl oxid) and about 4 
percent of alcohol, containing a little water. It is a transparent, 
colorless, mobile liquid, having a characteristic odor and a burning 
and sweetish taste. It is soluble in about ten times its volume in 
water and miscible in all proportions with alcohol, chloroform, and 
fixed and volatile oils. It boils at 96° F. (35.5° C.) . Ether is very 
inflammable, and should be kept in tightly stoppered tin cans in a 
cool place. 

Average Dose. — 15 minims (1 Cc). 

Ethyl Bromid; tEthylis Bromidum ; C 2 H 5 Br ; Bromic Ether ; 
Bromure d'Ethyle, F. ; Athylbromid, Bromathyl, G. 

Source and Character. — It is a haloid derivative, prepared by 
the action of sulphuric acid on alcohol and potassium bromid. It 
is a colorless, highly reactive, very volatile liquid, having a strong, 
ethereal odor and a sweetish, warm taste. It boils at about 103° F. 
(39.4° C), and burns with difficulty with a green flame. It is 



314 PHARMACO-THERAPEUTICS. 

very easily decomposed by light and air, turning brown, and then 
containing hydrobromic acid. It should not be confounded with 
ethylen bromid, a poisonous compound. 

Ethyl Chlorid ; ^Ethylis Chloridum, U. S. P. ; C 2 H 5 C1 ; Anti- 
dolerin; Kelene; Narcotile; Ciilorure d'Ethyle, F. ; 
Athylchlorid, Chlorathyl, G. 

Source and Character. — It is a haloid derivative, prepared by 
the action of hydrochloric acid gas on absolute ethyl alcohol. On 
account of its extreme volatility it is preserved in hermetically 
sealed glass or metal tubes. It is a colorless, mobile, very volatile 
fluid, having a characteristic odor and burning taste. It boils at 
about 55° F. (12.8° C), and burns with a smoky, green-edged 
flame. When liberated from its container it vaporizes at once, and 
the resultant gas is very inflammable. 

Ethyl chlorid is largely employed as a refrigerant local anes- 
thetic in minor surgery, and its specific application for such pur- 
poses is referred to under Local Anesthetics and Local Anesthesia. 

Methyl Chlorid; Methylis Chloridum; CH 3 C1. It is a gaseous 
compound, prepared by the action of hydrochloric acid on methyl 
alcohol in the presence of zinc chlorid. It is a colorless gas, having 
an ethereal odor. Under a pressure of five atmospheres at normal 
temperature it liquefies, forming a colorless, volatile' fluid. It boils 
at about —12° F. (—24.5° C.) . 

Carbon Tetrachlorid; Tetrachlormethan; CC1 4 . It is a trans- 
parent, colorless liquid, having an agreeable odor. It boils at 
170° F. (76.8° C). It is not used as an anesthetic, but is success- 
fully substituted for petroleum benzin, gasolin, etc., over which it 
has the advantage of being nonexplosive and noninflammable. 

Quite a large number of hydrocarbons, alcohols, aldehyds, 
esters, and halogen substitution compounds have been proposed at 
one time or another as general anesthetics ; they have been em- 
ployed only sporadically, and after a short sojourn have been dis- 
carded. Among the more prominent members of these groups are 
pental, ethylen chlorid, ethylidin chlorid, methylen bichlorid, and 
many others. Quite a large number of compounds of these groups, 



GENERAL ANESTHETICS. 315 

especially of the aldehyds, furnish important hypnotics — paralde- 
hyde sulphonal, trional, veronal, urethan, etc. 

Various mixtures consisting principally of alcohol, chloroform, 
ether, ethyl chlorid, etc., have also been favored as general anes- 
thetics. The A. C. E. mixture of Harley, consisting of 1 part of 
alcohol, 2 parts of chloroform, and 2 parts of ether, also known, 
when compounded in somewhat different proportions, as Billroth's 
mixture and the C. E. mixture, consisting of variable proportions 
of chloroform and ether, are prototypes of mixed general 
anesthetics. A few years ago Holland, of Bordeaux, introduced a 
mixture of low boiling halogen compounds into dentistry, which is 
known as somnoform. It consists of 60 parts of ethyl chlorid, 35 
parts of methyl chlorid, and 5 parts of ethyl bromid. Extravagant 
claims have been made for these mixtures by its vendors. Somno- 
form is by no means the "safest of all anesthetics;" a few deaths 
have been recorded following its use, and as soon as its name dis- 
appears from public print it will be forgotten, as it offers no 
advantage over pure chlorid. 

Physiologic Action of the Anesthetics of the Methan 

Series. 

Many theories have been promulgated regarding the action of 
general anesthetics. The principal theories are based on the fol- 
lowing suppositions : 

The absorbed gases partially arrest the oxidation as carried on in 
the tissues. 

The chemic character of the red blood corpuscles is changed. 

The anesthetic possesses a peculiar affinity for the nerve centers, 
and acts directly through the nerve cells on the various tissues. 

The anesthetic inhibits the function of the nerve centers, and 
produces anemia of the brain. 

None of these theories explains satisfactorily the action of nar- 
cotics. Recently a most interesting hypothesis regarding the action 
of anesthetics of the methan series has been suggested by Overton 
and Meyer, 1 and the soundness of their reasoning has found many 



1 Overton: Studien uber die Narkose, 1901. 



316 PHARMACO-THERAPEUTICS. 

supporters among the physiologists and pharmacologists. It is 
known as the chemico-physical theory of anesthesia. The general 
anesthetics, with the exception of nitrous oxid gas, are volatile 
organic compounds of the fatty series. The action of these sub- 
stances depends on certain specific interchanges which occur be- 
tween the drugs and the chemic constituents of the ganglion cells 
of the cerebrum. According to our present limited knowledge re- 
garding the composition of living albumin, we are unable to ex- 
plain the nature of these changes, but it is plausible to assume that 
this union between the drug and the cell albumin must be very 
labile, as no alterations occur within the cell contents. Further- 
more, this union is easily broken up, as anesthesia passes off 
quickly after the narcotic is stopped, and the patient awakens 
without apparent serious disturbances. The interchanges which 
occur between the ganglion cells and the anesthetic depend on cer- 
tain chemico-physical properties of the anesthetic. It is most im- 
portant that the narcotic is administered in vapor form, and that 
this vapor is mixed in certain proportions with the inspired air, so 
as to bring it into intimate contact with the circulating blood in 
the alveoli of the lungs. The blood, which is saturated with the 
anesthetic vapor, carries it to- all the tissues of the body, but the 
ganglion cells possess special affinity for the narcotic and quickly 
absorb this poison from the blood. If the further supply of the 
anesthetic is now stopped, the inner pressure of the narcotic vapor 
present in the blood ceases, the gas is exhaled from the. lungs, and 
the blood, which is now free from tension, reabsorbs the anesthetic 
from the ganglion cells and carries it to the lungs, to be exchanged 
for normal air. This process of removal is continued until all of 
the anesthetic is exchanged for normal air. Aside from the inner 
pressure existing between the blood and the. lungs, another factor 
plays an important role in regard to pharmacologic action in gen- 
eral and in anesthetic action in particular — it is the solubility of 
the narcotic in the cell constituents. All protoplasm contains cer- 
tain fatty substances composed of lecithin and cholesterin, which 
are known as lipoids. The ganglion cells are especially rich in 
lipoids, and they are known to possess a special affinity for nar- 
cotics. Recent experiments have shown that those drugs which do 



GENERAL ANESTHETICS. 317 

not enter into living cells, or enter only with difficulty, are more or 
less insoluble in fatty oils, but they are readily soluble in water. 
On the other hand, those drugs which are readily soluble in oils are 
usually more or less insoluble in water, and they quickly penetrate 
into the protoplasm of the cells. As stated above, the narcotic acts 
on all tissue cells, but, as the ganglia are especially rich in lipoids, 
the absorption of the narcotic, based on their readily solubility in 
oils, takes place very rapidly. To explain this phenomenon on a 
physical basis, the following simple test will elucidate this factor: 
A saturated solution of chloroform in water (1 in 200) is vigor- 
ously agitated with a fatty oil (cottonseed oil) ; after the separa- 
tion of the oil and water has taken place, the chloroform will be dis- 
solved in the oil, and the water is found practically free from it. 

Some years ago Schleich 1 made the statement that an anesthetic 
which has a boiling point much below the normal temperature of 
the body is always dangerous, and that the narcotic which boils 
slightly above the normal temperature is, relatively speaking, the 
safest anesthetic. This statement is untenable, as shown by a com- 
parison of the various boiling points of anesthetics. The boiling 
points of the more common anesthetics are as follows : 

Chloroform 141° F. (60.5° C). 

Ethyl bromid 103° F. (39.5° C. ). 

Ether '. 96° F. (35.6° C). 

Ethyl chlorid 55° F. (12.8° C). 

Methyl chlorid — 12° F. (—24.5° C). 

Nitrous oxid —126° F. (—88° C). 

A comparison of the boiling points of these various anesthetics 
and their mixtures leads us to believe, if we base this belief on 
statistics of the death rate from their administration (see following 
table), that the lower the boiling point apparently the safer the 
anesthetic. Nitrous oxid has the lowest boiling point, and is by far 
the safest of all general anesthetics. A comparison of the tables 
seems to indicate that the time for inducing the anesthesia, its 
duration, and its completeness are in direct ratio with the boiling 
point of the individual anesthetic. There is much room for further 
elucidation of this interesting subject. 

1 Schleich: Schmerzlose Opera tionen. 1902. 



318 PHARMACO-THERAPEUTICS. 

Statistics concerning the death rate from the various anesthetics 
are unreliable guides in regard to their safety. Many contributory 
factors, which it is impossible to exclude, alter the relative value of 
these statistics to such an extent as to render them quite prob- 
lematic. From recent statistics, covering 1,146,493 narcoses, the 
following figures are obtained : 

Chloroform 1 death in 3,500 administrations. 

Ether 1 death in 26,268 administrations. , 

C. E. mixture. . . 1 death in 8,014 administrations. 

The German Central Society of Dentists has prepared a series of 
records of the number of general narcoses and their fatalities, 
which are tabulated from the reports of its members, covering a 
period of four years (1902 to 1905). These statistics resulted ir» 
the following report: 

Chloroform 1 death in 42,215 administrations. 

Ethyl bromid. . . 1 death in 121,154 administrations. 

Ethyl chlorid . . . No death in 70,630 administrations. 

Nitrous oxid. . . . No death in 3,062 administrations. 

SYMPTOMS OF ANESTHESIA. 

The action of an anesthetic on the general system may be con- 
veniently divided into three stages — semi-unconsciousness, excite- 
ment, and anesthesia. These various stages are more defined 
under chloroform and ether, but less under ethyl chlorid, and still 
less under nitrous oxid. 

The first stage is usually ushered in by the feeling of choking, 
especially when ether is employed, and a peculiar warmth of the 
whole body. The senses become less acute, ringing and roaring 
in the ears is very pronounced, and the limbs seem to become 
heavy and stiff. The pupils enlarge, the face becomes flushed, 
and the pulse is slightly accelerated, while the respiration is more 
or less irregular. The second stage, or excitement, differs very 
markedly with the individual. In children it is often absent, 
while it is usually most pronounced in those addicted to alcohol. 
The patient exhibits tremor of the muscles, with stretching of the 
limbs, and often tries to push away the inhalation mask. Dream- 



GENERAL ANESTHETICS. 319 

like impressions disturb his vanishing consciousness, and he may 
ghout, sing, groan, or manifest other signs connected with his 
mixed thoughts concerning the operation or his surroundings. 
The pulse is usually very irregular, the skin is flushed and cya- 
notic, and the pupils remain dilated. With the progress of anes- 
thesia the third stage is reached — the patient becomes quiet, his 
muscles relax, the face assumes a calm, death-like appearance, and 
the reflexes disappear. The respiration becomes more regular 
again, but remains shallow and slow. As soon as complete anes- 
thesia is reached, extreme care is necessary to prevent {he respira- 
tion from becoming still more shallow. After the narcosis the 
patient again passes through a stage of excitement, although less 
pronounced, which may last longer than the initial excitement. 
The patient usually falls asleep, which is sometimes interrupted by 
nausea, giddiness, and vomiting. 

Administration of Ethyl Chlorid. 

The administration of ethyl chlorid may be divided, according 
to the method employed, into three different modes, and each one 
requires specific apparatus for its correct application. 

The open method consists in spraying or dropping the ethyl 
chlorid on a cone made of surgical gauze or on an ordinary chlo- 
roform mask. If a mask is used, it must be thoroughly covered 




ui <£* .£> co c» ru j\9 — — 
©Ot© tnoviocn© v» © 



For Geheral Anaestmesja 



Figure 41. 
Ethyl Chlorid Dropping Tube. 



with a double thickness of gauze or flannel stretched tightly over 
the metal frame. The ethyl chlorid is carefully dropped or 
sprayed from a specially prepared dropping tube directly on the 
gauze. The open method has one objection — a great deal of ethyl 
chlorid is wasted, as three or four times as much is used as is ordi- 
narily required for the semi-open method. 



320 PHARMACO-THERAPEUTICS. 

The semi-open method consists in spraying the ethyl chlorid 
on a specially devised mask or inhaler. The Ware inhaler, the 
narcotile inhaler, the Herrenknecht or Ferguson mask, or the 
Seitz mask are the principal apparatus employed for this method. 
Some of these inhalers — the Seitz mask — are too complicated to be 
of practical use. The Ferguson inhaler, on account of its simplic- 
ity, is preferred by many anesthetists. Its construction is based 
on the principle originally adopted, and which is still successfully 
employed by Herrenknecht in the Dental Clinic of the University 
of Freiburg. It consists essentially of a modified Esmarch mask, 
having two chambers, which are separated by a replaceable convex 
diaphragm made of surgical gauze. The mask is covered with 
rubber cloth; the opening G is to be drawn together to between 




Figure 42. 
Ferguson Inhaler. 

one-half and three-quarters of an inch in diameter, and the ethyl 
chlorid is sprayed or dropped through it on the gauze during in- 
spiration only. If during expiration the opening G be closed by 
the fingers and the mask tilted to allow the expired air to escape 
between the mask and the face, the induction of the anesthetization 
will be more rapid, and less ethyl chlorid will be used. The aver- 
age amount of anesthetic used by this method amounts to 30 to 
45 minims (2 to 3 Cc), and rarely over 75 minims (5 Cc.) are 
used. The open and semi-open method of ethyl chlorid adminis- 
tration is rarely accompanied by nausea or vomiting. This is 
probably due to the presence of an abundance of fresh air and the 
avoidance of inspiring the chlorinated decomposition products, 
as occurs in the closed method. 

The closed method requires, in the main, an air-tight bag for 
the retention of the ethyl chlorid vapors, provided with a suitable 



GENERAL ANESTHETICS. 



321 



inhaler. An ethyl chlorid tube containing 45 or 75 minims (3 
or 5 Cc.) is wrapped in cotton and placed in the soft rubber bag 
of a Clover, Dawbarn, or similar inhaler; breaking the tube by 
pressure through the walls of the rubber bag releases the anes- 
thetic. Eecent improved inhalers carry a special tubular arrange- 




Eihyl Chloride. Squibb 

Tor General anaesthesia 



23r &B^;S!^S.&<SQ?n J 




Figure 43. 
Ethyl Chlorid Tube. 



ment for breaking the ethyl chlorid tube outside of the bag to 
prevent the entering of glass splinters. Quite a large number of 
special inhalers have been constructed on this principle, among 
which the somnoform inhaler and those of Robinson, McFarlane, 
Lobjois, Stark, and Green are probably the best known. The 




Figure 44. 
Ermold-Stark Inhaler. Sectional view. 



Ermold-Stark inhaler is a good type of apparatus to be used for the 
closed method. It consists of a metal mask, A, with inflated cush- 
ion, B, connected with a rubber reservoir, C, into which a maga- 
zine, D, opens. This magazine is made to hold a 5-cubic-centi- 
meter tube of ethyl chlorid, which is broken by pressing cap E 



322 



PHARMACO-THERAPEUTICS. 



down. Thus the ethyl chlorid escapes as a gas into the bag, and 
is readily inhaled through the mask. G is a valve so arranged that 
by moving knob F the patient may be made to gradually, yet 
rapidly, pass from the breathing of pure air to the inhalation of 
pure ethyl chlorid. Broken glass can not enter either the bag or 
mask. In the mask is a metal gauze diaphragm to retain surgical 
gauze in order to permit it, when removed from the rest of the 
inhaler, to be used for administering ether by the drop method. 




Figure 45. 
McFarlane's Ethyl Chlorid Inhaler. 



If preferred, the inhaler may be charged from time to time with 
ethyl chlorid by removing cap E and spraying into the bag 
through magazine D ethyl chlorid from a large tube with auto- 
matic closure, specially gauged for general anesthesia. 

Quite a different principle of applying a continuous small 
stream of ethyl chlorid is involved in the Gebauer combination 
inhaler. This inhaler is favored by many surgeons, as the supply 
of ethyl chlorid gas is always under perfect control. The appa- 



GENERAL ANESTHETICS. 



323 



ratus is comparatively simple in construction, easily sterilized, and 
ether may be administered with it as a sequence without removing 
the face piece. The Gebauer inhaler consists of a metal cone face 
piece, A. provided with a pneumatic air pad, B, attached around 
its lower edge. On top of the cone is a removable casing or tap, 
C, provided with an exhaling valve, D, and a tube connection, E. 
The upper portion of the cone is provided with a wire frame work, 




Figure 46. 
Gebauer Combination Inhaler. 



F, interwoven with absorbent gauze. When the inhaler is used for 
ether or chloroform alone, the cap is removed and the anesthetic 
is dropped on the absorbing gauze, the same as when ether or 
chloroform is administered by the drop or open method. The 
change from ethyl chlorid to ether can be made instantly by 
simply removing the top cap, C, without changing the position of 
the cone on the face. The exhaling valve, D, is so constructed that 
it will permit the right quantity of air to enter into the inhaler 



324 PHARMACO-THERAPEUTICS. 

with every inhalation, and also allow the patient to exhale freely, 
thus avoiding cyanosis. The vibrating diaphragm in this valve 
acts also as an indicator for the respiratory movements. The top 
of the container is provided with a screw valve, which regulates the 
supply of ethyl chlorid vapors. The vapors are transmitted to the 
inhaler by means of the rubber tube, I. In administering the 
ethyl chlorid, the container is held in the right hand, the warmth 
of which causes the ethyl chlorid to vaporize, and by opening the 
valve is introduced into the inhaler. 

Preparation of the Patient. 

A patient who wishes to undergo an operation under an anes- 
thetic requires certain preparation. This preparation varies with 
the nature of the operation. The anesthetization for a dental opera- 
tion, which is usually completed within a few minutes and which 
is conducted under nitrous oxid or ethyl chlorid, requires a less 
elaborate preparation of the patient than a major operation under 
chloroform or ether. If possible, the patient should have his 
bowels emptied by a purgative, given the night before the opera- 
tion. Very little food should be taken on the following morning 
— a cup of tea or coffee and a little toast are sufficient for break- 
fast. The best time to operate is the early forenoon — at 9 o'clock 
— as the body is at its highest resistance at that hour. 

Choice of the Anesthetic. 

Nitrous oxid and ethyl chlorid are the two anesthetics which 
are principally employed in the United States and England for 
short dental operations, while in other countries, especially in Ger- 
many and Austria, ethyl bromid is probably used more than any 
other anesthetic for such purposes. The general condition of the 
patient will determine what anesthetic is indicated in his particu- 
lar case; sex and age are of little consequence in regard to its 
choice, and the very young and elderly patients are especially good 
subjects for N 2 or ethyl chlorid. Patients suffering from bron- 
chitis and pulmonary tuberculosis must be carefully watched to 



GENERAL ANESTHETICS. 325 

avoid undue cyanosis if N 2 is given ; a liberal supply of oxygen 
should always be administered with it. 

According to Luke, 1 the available time for the various anesthet- 
ics may be roughly estimated as follows: 

Nitrous oxid 30 seconds. 

Nitrous oxid and ethyl chlorid 90 to 120 seconds. 

Nitrous oxid (nasal method) 1 to 5 minutes. 

Nitrous oxid and ether 1 to 10 minutes. 

Ethyl chlorid 1 to 2 minutes. 

Ethyl chlorid and ether 1 to 10 minutes. 

Ethyl chlorid and C. E 2 to 5 minutes. 

C. E. mixture and ether sequence. . . 3 to 10 minutes, or ad lib. 

For the average dental operation, nitrous oxid, alone or in com- 
bination with oxygen, is, as stated, by far the safest of all anesthet- 
ics. On account of the somewhat cumbersome apparatus, many 
operators have discarded it at present for ethyl chlorid or its mix- 
tures. The relative safety of the latter compounds is much less 
than that of nitrous oxid. Chloroform and, to some extent, ether 
should not be employed as anesthetics for minor dental operations. 
The many deaths Avhich have occurred from the use of chloroform 
in dental operations probably find an explanation in the danger- 
ous upright position of the patient when seated in the operating 
chair and in incomplete anesthesia (Rausch anesthesia). 

Treatment of Accidents of General Anesthesia. 

The disturbances resulting from the administration of anesthet- 
ics, which to a more or less degree involve the various functions 
and tissues of the body, may conveniently be classified as those 
affecting, first, the digestive apparatus ; second, the circulation ; 
third, the respiration; and fourth, the nervous system. Disturb- 
ances in the digestive apparatus usually manifest themselves in 
two distinct varieties — in nausea and in vomiting. By nausea we 
understand that well-known sickening feeling, accompanied by 
retching and a desire to vomit. It is the direct result of reflex 
movement of the pharynx, esophagus, and stomach, and is most 
likely caused by the irritating vapor of the anesthetic. It is 



1 Luke: Loc. cit. 



326 PHARMACO-THERAPEUTICS. 

primarily noticed in connection with the administration of chloro- 
form, ether, and ethyl bromid, and rarely with ethyl chlorid or 
nitrous oxid gas. Treatment is seldom called for, as nature usually 
helps herself. If we wish to overcome nausea by drug administra- 
tion, small doses of spirit of peppermint or of valerian prepara- 
tions are recommended; especially validol, a compound of men- 
thol and valerianic acid, deserves to be mentioned. Vomiting- 
results from complicated conjoint movements of the diaphragm, 
the stomach walls, and the glottis. It is naturally oftener noticed 
in cases where a full meal is taken shortly before the anesthetic 
is administered; it rarely occurs in laughing gas narcosis. By 
vomiting the stomach empties itself, and, except dieting for a short 
time, no further treatment is required. It is essential to clear the 
mouth and throat from all vomited matter as soon as possible to 
avoid obstruction of the air passages. 

Disturbances of the circulation are very dangerous. While they 
can not be directly observed upon the organs of circulation or the 
blood, fortunately they manifest themselves externally to the 
trained eye by various color manifestations — cyanosis or extreme 
pallor. Cyanosis is the expression of severe congestive hyperemia, 
resulting from accumulation of venous blood — a subcharge of car- 
bonic acid. The blue color appears primarily on the end organs 
of the body — the lips, cheeks, fingers, nose, etc. Cyanosis is always 
present in dyspnea and asphyxia. Lipothymia, or fainting, is a 
temporary inhibition of the functions of the brain, resulting from 
cerebral anemia, usually accompanied by more or less complete in- 
hibition of all senses. If the heart should stop completely, general 
collapse may result. A specific variety of collapse which is marked 
by the suddenness of complete heart failure is referred to as 
syncope. This syncope, when occurring in the early stages of 
administering a narcotic, and when accompanied by a typical star- 
ing of enlarged or reduced pupils, indicates idiosyncrasy to the 
narcotic used. The treatment of the disturbances of circulation 
consists in applying mechanical and chemic means to bring about 
increased or renewed heart action. Artificial respiration and 
powerful rhythmic compression of the heart's region are essential. 
The compression of the heart is best accomplished by standing on 



GENERAL ANESTHETICS. 327 

the Left aide of the patient, and forcefully pressing with the night 
thumb into fche regidsa between the apes of the heart and the left 
w;ill of fche sternum; the left hand should be plaeed over the 
righl thoracic region of the patient to steady the body, and coin- 
pression should !»«■ applied about ;i hundred times a minute. Slap- 
ping !!)'■ fact- and chest of fche patient with fcewelfi wrung out in 

cold water acts ae an active reflex stimulant. Nelaton suggests 
lowering the la-ad, or complete Diversion of (he hody, to promote 
rapid flow of Mood lo the anemic brain. Both means produce ex- 
eelleni results. Stimulation by diema- agents consists of applying 
strong irritating, substances to fche nostrils. In the early stages of 
collapse, ammonia, in (lie form of smelling salts or in its various 

solutions, acetic ether, can de Cologne, etc.. are indicated. As a 

powerful dilator of the peripheral vessels, the vapors of amy] ni- 
trite are exceedingly useful by placing three to five drops of this 

fluid on a napkin ;md holding it before the nostrils for inhalation : 

(lushing of (he face mid an increase of the frequency of the pulse 
follow almost instantly. Nitroglycerin solution manifests a simi- 
lar typical nitrite action. Aromatic spirit of n 1 1 in ion in . ill half- 
teaspoonful doses, well diluted, is much lauded for such purposes. 

Perfect respiration is absolutely essential to aerate the blood in cir- 
cular disturbances. 

Disturbances of respiration are cither mechanical or functional 
in their nature. To avoid possible mechanical obstruction during 
narcosis, which may occlude (he trachea, careful inspection of the 
oral cavity should always he resorted to before beginning to anes- 
thetize. Artificial teeth, removable bridges, chewing gum, to- 
bacco, and many Other things may he looked for in (he mouth. 

In extracting teeth, extreme care should be exercised to actually 
deposit (he tooth outside of the mouth. A tooth is Liable to spring 

from the forceps, or, when forced from an alveolus by an elevator, 
may fall backward and enter the trachea. To avoid such an oc- 
currence. Carter's oral net spoon has been devised. If (he .-lipped 
tooth can not he caught with (he finger or an instrument, an effort 
should he made, in extreme oases only, lo force the tooth into the 

gullet by pushing it hack ward and a little to the left, thus gaining 

entrance into the esophagus. 



328 



PHARMACO-THERAPEUTICS. 



In the early stages of anesthesia, occasionally inhibition of 
respiration is produced by tonic spasms of the muscles of the 
tongue, thus forcing this organ against the soft palate and the 
posterior wall of the pharynx. This same phenomenon may occur 
during profound anesthesia in a patient assuming a recumbent 
position. To overcome stenosis of the larynx, the lower jaw should 
be thrown forward by pressing against the two rami posteriorly. 
This movement is known as Esmarch (English) or Howard 
grip. A tongue forceps may be inserted and the tongue pulled 
forward, or even piercing the tongue with a needle threaded with 
stout silk and applying rhythmic traction has been resorted to. 

The typical organic impairments of respiration are known as 




• •■-- 



Figure 47. 
Artificial Respiration. Expiration, Sylvester's method. 



apnea, dyspnea, and asphyxia. The differentiation between these 
three forms of suffocation rests probably more with the severity 
of the disturbance than w T ith the kind; they are primarily the 
result of a lesser or greater paresis of the respiratory centers. The 
supreme remedy is artificial respiration — an artificial means for 
the thorough ventilation of the blood and lungs, replacing the 
narcotic with air until normal functions of the organ are estab- 
lished. One of the older methods of forcing air into the system 
is the mouth-to-mouth insufflation, a method which today is 
abandoned ; the same is true of the bellows method. Artificial res- 
piration may be applied by any of the known methods that serve 



GENERAL ANESTHETICS. 



329 



its purpose, provided the employed method is thoroughly under- 
stood. 

Sylvester's method of resuscitation is probably most universally 
employed. It is carried out as follows: Place the patient on the 
back, with a roll of clothing under the shoulders. Pull the tongue 
forward and retain it in that position to allow the free entrance of 
air into the windpipe. The operator stands at the head of the 
patient and grasps both arms midway between the elbows and 
wrist joints; the arms are drawn upward until the hands are car- 
ried high above the head, and kept in this position until 1, 2, 3 
can be counted slowly. The elbows are now slowly carried down- 




FlGURE 48. 

Artificial Respiration. Inspiration, Sylvester's method. 

ward, placed by the side of the trunk and inward against the 
chest. This movement should be continued at the rate of fifteen 
to sixteen times a minute, and may be continued for an hour or 
more if needed. 

Howard's method of resuscitation has recently been advocated. 
It is carried out as follows : Place the patient on the back, with a 
roll of clothing under the thorax. All clothing obstructing the 
neck, chest, and abdomen must be loosened. The tongue is pulled 
forward and held in that position to allow the free entrance of air. 
Kneel astride the patient's hips and place your hands on his chest ; 
the ball of each thumb rests on the inner margin of the free border 



330 PHARMACO-THERAPEUTICS. 

of the costal cartilages, the tip of each thumb is near or on the 
ensiform cartilage, and the finger tips are placed into the cor- 
responding intercostal spaces. The elbows of the operator are 
firmly pressed against the patient's sides and the upper portion 
of his hips. Press upward and inward toward the diaphragm, and 
throw the weight slowly forward two or three seconds until the 
face almost touches that of the patient, ending with a sharp push, 
which helps to jerk the operator back to the erect kneeling posi- 
tion. Now rest three to five seconds, and repeat the same move- 
ment at the rate of seven to ten times a minute until natural res- 
piration is established. 

Faradization of the diaphragm is sometimes useful; too much 
should not, however, be expected from the electric current in this 
connection. Dilating the anus with a suitable speculum is also 
recommended. A careful and quickly instituted artificial respira- 
tion is the alpha and omega of all methods of resuscitation. The 
proper use of the first minute is of more real value in the preserva- 
tion of the extinguishing life than all the hours thereafter. No 
precious moments should be lost by rubbing the patient, applying 
smelling salts, or other secondary means. Artificial respiration 
may often be profitably continued for an hour or longer until 
fairlv normal lung activitv is established. 

As far as medication is concerned, the only drug that has proved 
to be of value in this connection is strychnin in full doses by means 
of hypodermic injections. 

Nervous disturbances during or following anesthesia usually 
manifest themselves in two definite forms — in those affecting the 
psyche and those unbalancing the motor centers. Psychic ex- 
citement is a common occurrence in the preliminary stages of 
narcosis; hysterics and alcoholics furnish by far the largest con- 
tingent. Intense muscular exertion, combined with clonic or tonic 
spasms, frequently result in an increased pulse rate, with more 
or less cyanosis and stertorous respiration. If we possess an anam- 
netic clue in regard to existing hysteria or alcoholism, a hypoder- 
mic injection of morphin half an hour before beginning of the 
narcosis will materially lessen this preliminary excitement. Occa- 
sionally we meet a patient who will awake from the anesthetic 



GENERAL ANESTHETICS. 331 

with apparent normal physical condition, but without perfect con- 
trol of the sensorium. The patient remains for some minutes in 
a sort of lethargic sleep, which may at times reach a deep comatose 
state. Smelling salts held to the nostrils, cold water dashed in 
the face, and loud talking or shaking will arouse the patient. Dis- 
turbances of the motor centers result in more or less severe spasm. 
Singultus, the ordinary hiccough, is often seen in the early stages 
of inhalation. Tremor of a single group of muscles or of the 
entire body is noticed more or less frequently after the taking of 
smaller quantities of the narcotic; similar tremors as a result of 
indulging in other narcotics — as tea, coffee, or tobacco — are no- 
ticed in those who are not habitues of these drugs. These muscle 
tremors are usually confined to the early stages of inhalation, and 
are not dangerous. If they should occur after the anesthetic 
passes off, the strong will power of the patient materially assists 
in readily overcoming these tremors. Convulsions, combined with 
clonic or tonic spasms, occur frequently under nitrous oxid anes- 
thesia, but much less under the other narcotics. Care should be 
exercised to prevent the patient from hurting himself. The re- 
moval of the anesthetic quickly relieves the condition. Tetanus — 
the persistent contraction of voluntary muscles — is frequently seen 
in the early stages of anesthesia; less, however, when chloroform 
is used. Typical trismus — tonic spasms of the muscles which are 
supplied by the fifth pair of nerves, especially those of mastica- 
tion — is often very troublesome in dental anesthesia. As a pre- 
caution, a suitable mouth prop should always be put in place. 
Severe forms of tetanic convulsions, bending the head and feet 
backward, known as opisthotonos, are also seen under anesthesia 
in the early stages. All these muscle disturbances rarely call for 
treatment, but carefully watching the patient to prevent hurting 
himself is, however, indicated. 

In dental literature reference is frequently made to "shock from 
the anesthetic." By shock is meant the depression resulting from 
an injury or an operation, and we are inclined to believe that these 
"shock stories" of anesthesia can be properly placed under the vari- 
ous disturbances within the four divisions of anesthesia sequences 
if a correct diagnosis is made. 



332 PHARMACO-THERAPEUTICS. 

For the purpose of readily meeting unexpected side effects of 
anesthetics, every practitioner should provide himself with a stock 
of emergency drugs, placed in an easily accessible compartment of 
his medicine chest, consisting of : 

Hypodermic tablets of strychnin sulphate, 1 / 30 grain. 

Hypodermic tablets of nitroglycerin, y i00 grain. 

Amyl nitrite, in 5-drop glass capsules. 

Validol. 

Aromatic spirit of ammonia. 

Smelling salts. 

Whisky. 

Hypodermic syringe in good working order. 



HYPNOTICS. 

Hypnotics (sleep producers), sometimes referred to as sopo- 
rifics or somnifacients, are drugs applied for the purpose of in- 
ducing sleep. Incidentally they relieve pain by paralyzing cer- 
tain parts of the cerebrum, and consequently they are closely re- 
lated to general anesthetics, narcotics, anodynes, and analgesics. 
From the viewpoint of the pharmacologist, hypnotics can not be 
classified as a specific group of remedies, but for clinical purposes 
this grouping answers satisfactorily. Some of the hypnotics are 
soluble in water, others are not ; all are, however, soluble in fatty 
oils. No plausible explanation has as yet been offered regarding 
the action of hypnotics. Sleep and wakefulness are periodical 
functions of the central nervous system, which occur at rhythmical 
intervals. These periodical functions are often irritated by ex- 
ternal and internal disturbances. Physical and mental strain, 
nervous diseases, lessened resistance, and many somatic disturb- 
ances are frequent causes of insomnia. Sleep should not be arti- 
ficially induced at once in every case in which the patient com- 
plains of insomnia ; regulating the diet, proper exercise, eliminat- 
ing the nervous disturbances, lukewarm baths, etc., are of prime 
importance in inducing natural sleep. Hypnotics should not be 
given for an extended time, as they are very prone to create habits. 



HYPNOTICS. 333 

It is often advisable to change the remedy at short intervals if it 
must be given for a long period. 

Hydrated Chloral; Chloralum Hydratum, U. S. P.; Chloral 
Hydras, B. P.; C 2 HC1 3 0+H 2 ; Hydrate de Chloral, F. ; 
Chloralhydrat, G. 

A crystalline solid, having an aromatic, penetrating, and slight- 
ly acrid odor and a bitter, caustic taste. It is freely soluble in 
water, alcohol, ether, chloroform, and fixed and volatile oils. It 
is usually prescribed in diluted solutions, syrup, etc. Its irritant 
properties prohibit its use for hypodermic purposes. 

Average Dose. — 15 grains (1 Gm.), repeated, if necessary, in 
one or two hours. 

Sulphonmethan; Sulphonmethanum, U. S. P.; Sulphonal, B. 
?. : C 7 H 1G S 2 4 . A white powder or colorless crystals, without 
odor and taste. It is soluble in 360 parts of water and 47 parts of 
alcohol. It is usually administered in powder form, followed 
by a cup of hot milk, an hour or two before retiring. Average 
dose, 15 grains (1 Gm.). 

Sulphonethylmethan; Sulphonethylmethanum, U. S. P.; C 8 H 13 
S,0 4 ; Trional. It closely resembles sulphonal, but is more soluble. 
Average dose, 15 grains (1 Gm.). 

Paraldehyd; Paraldehydum, U. S. P. ; B. P. ; C 6 H 12 3 . A color- 
less, transparent fluid, having a strong, characteristic odor and a 
burning taste. It is preferably prescribed in weak alcoholic solu- 
tions. Average dose, 30 minims (2 Cc). 

Butylchloral Hydrate; Butylchloral Hydras, B. P.; C 4 H 7 2 C1 3 ; 
Croton Chloral Hydrate. It resembles chloral hydrate very closely 
in its action, but it is said to be less depressing and more analgesic. 
It has been especially recommended in facial neuralgia. Average 
dose, 15 grains (1 Gm.). 

Ethyl Carbamate; jE thy lis Carbamas, U. S. P.; C 3 H 7 N0 2 ; 
Urethan. Colorless crystalline masses, with a cool, saline taste. It 
is soluble in 1 part of water, 0.6 parts of alcohol, ether, etc. Aver- 
age dose, 15 grains (1 Gm.). 

Veronal; Veronalum; C 8 H 12 3 N 2 ; Diethylmalonylurea. It is a 
white crystalline powder, odorless, and faintly bitter to the taste. 



334 PHARMACO-THERAPEUTICS. 

It is soluble in about 150 parts of water. It is best given in powder 
form, followed by a cup of hot milk or tea. In small doses it is 
claimed to be a relatively safe hypnotic. Average dose, 7 1 / 2 grains 
(0.5 Gm.). 

There are a large number of other hypnotics which have been 
more or less prominent before the profession, among which are 
amylen hydrate, chlorotone, hedonal, isopral, petronal, etc. 

Sleeping Draughts. 

fy Chlorali hydrati 3 ij (8.0 Gm.) 

Syr. limonis 
Aquae aa fl£ ss (15 Cc.) 

M. 

Sig. : Teaspoonful in half a glass of water an hour before 
retiring. 

For Facial Neuralgia. 

Ifc Butyli chlorali hydrati 3 J ss (6.0 Gm.) 

Syr. limonis fig ss (15 Cc.) 

Aquae ad flg ij (60 Cc.) 

M. 

Sig.: Teaspoonful in half a glass of water, followed in 
ten minutes by a second dose. 



ANODYNES. 

Anodynes, sometimes referred to as analgesics (without or 
against pain) and as narcotics (to stupefy), are remedies employed 
for the purpose of relieving pain. By pain we understand the 
conscious manifestation of morbid changes within the nerve 
centers caused by some form of irritation, and is usually mani- 
fested at the periphery. Anodynes are administered internally, 
and act by inhibiting the sensory functions of the central nervous 
system. They do not form a specific pharmacologic group of 
remedies, but are closely related in their general action to the gen- 
eral anesthetics. The action of the latter group inhibits not alone 
the sensory functions, but also the motor functions and con- 
sciousness. When anodynes are locally applied, they are* often 
referred to as local anesthetics. General anesthetics are rarely 



ANODYNES. 335 

employed for the purpose of relieving pain, and are principally 
used to prevent pain. The foremost drugs which are employed 
to relieve pain are opium and its alkaloids and certain compounds 
of the aromatic series. The latter are, however, principally used 
to reduce the temperature of the body, and thereby they may act 
indirectly as antineuralgics. The most important anodyne is 
morphin ; it is the sovereign remedy in all cases where severe pain 
has to be controlled. 

Opium; Opium, U. S. P., B. P.; Opium, F., G. 

It is the dried milky exudation obtained by incising the unripe 
capsules of the opium plant, Papaver somniferum. It should 
yield, when moist, not less than 9 percent of crystallized morphin. 

Average Dose. — ly 2 grains (0.1 6m.). 

Preparations. — 

Powdered Opium; Opii Pulvis, U. S. P.; Dried Powdered 
Opium. It should yield 12 percent of crystallized morphin. 
Average dose, 1 grain (0.06 Gm.). 

Tincture of Opium; Tinctura Opii, U. S. P., B. P. ; Laudanum; 
Teinture Thebaique, F. ; Opium tinktur, G. It contains 10 percent 
(about 7y 2 percent, B. P.) of opium. Average dose, 8 minims 
(0.5 Cc.) ; 15 minims (1 Cc), B. P. 

Tincture of Deodorized Opium ; Tinctura Opii Deodoratx, U. S. 
P. It contains 10 percent of opium. Average dose, 8 minims 
(0.5 Cc). 

Camphorated Tincture of Opium; Tinctura Opii Oamphorata, 
U. S. P. ; Tinctura Camphor se Composita, B. P. ; Paregoric. It 
contains 4 parts of opium in 1.000 parts of the tincture. Average 
dose, 2 fluidrams (8 Cc). 

Morphin Acetate; Morphines Acetas, U. S. P., B. P.; C 17 H 10 
N0 3 .C 2 H 4 2 +3H 2 0. A white or yellowish crystalline powder, 
having a slight odor and a bitter taste. It is soluble in about 2.5 
parts of water and 25 parts' of alcohol. Average dose, 1 / 4 grain 
(0.015 Gm.). 

Morphin Hydrochloride" Morphines Hydrochloridum, U. S. P., 
B. P. ; C 17 H ]0 NO 3 .HCl+3H 2 O. It appears in white, silky, glisten- 
ing needles, or in small crystalline cubes, odorless, and having a 



336 PHARMACO-THERAPEUTICS. 

bitter taste. It is soluble in about 20 parts of water and 50 parts 
of alcohol. Average dose, 1 / 4 grain (0.015 Gm.). 

Morphin Sulphate; Morphinse Sulphas, U. S. P. ; (C 17 H 19 N0 3 ) 2 . 
H 2 S0 4 +5H 2 0. White, feathery crystals or cubical masses, odor- 
less and having a bitter taste. It is soluble in about 16 parts of 
water and about 500 parts of alcohol. Average dose, V 4 grain 

(0.015 Gm.). 

Solution of Morphin Hydrochlorid; Liquor Morphinse Hydro- 
chloridi, B. P. A 1-percent solution of morphin hydrochlorid. 
Average dose, 15 minims (1 Cc). 

Hypodermic Morphin Injection; Injectio Morphinse Hypoder- 
mica, B. P. It contains 1 percent of morphin tartrate, and is used 
for hypodermic injections. Average dose, 4 minims (0.25 Cc). 

Codein Phosphate; Codeinas Phosphas, U. S. P., B. P.; C 18 H 21 
N0 3 .H 3 P0 4 +2H 2 0. It appears in fine white, needle-shaped crys- 
tals, or as a crystalline powder, odorless, and having a very bitter 
taste. It is soluble in about 2.5 parts of water and 255 parts of 
alcohol. Average dose, 1 / 2 grain (0.03 Gm.). 

Compound Powder of Morphin; Pulvis Morphinse Compositus, 
U. S. P. ; Tully's Powder. It contains 1.5 percent of morphin sul- 
phate, together with camphor, licorice, and calcium carbonate. 
Average dose, 7 1 / 2 grains (0.5 Gm.). 

Powder of Ipecac and Opium; Pulvis Ipecacuanhas et Opii, 
U. S. P. ; Pulvis Ipecacuanhas Compositus, B. P. ; Dover's Powder. 
It contains 10 parts of ipecac, 10 parts of opium, and 80 parts of 
sugar of milk. Average dose, 7 1 / 2 grains (0.5 Gm.). 

Therapeutics. — Morphin, when given in average doses, in- 
hibits the entire function of the cerebrum, and thereby abolishes 
sensibility to pain and produces sleep. It reduces the irritability 
of the centers of respiration, and almost invariably contracts the 
pupils, but this latter action is not utilized therapeutically. The- 
circulation is not affected by morphin. The peristaltic move- 
ment of the bowels is usually lessened by this narcotic. 

Morphin is a powerful poison, and kills by paralyzing the cen- 
ters of respiration. Man is by far the most sensitive being as re- 
gards the action of morphin. The lower the organization of the 
animal, the less reaction is produced by this poison. Bacteria are 



ANODYNES. 337 

not influenced by its solution. Small children are very sensitive 
to opium and morphin ; even very small doses may produce dan- 
gerous symptoms. 

Morphin is readily absorbed, especially when injected hypo- 
dermically, and manifests its action within a few minutes. In 
most people it produces at first very slight excitement, which is 
immediately followed by psychic rest and a feeling of content- 
ment, with more or less inhibition of volition. A state of general 
analgesia results, without interfering markedly with the cerebral 
functions. Morphin does not produce general or, when applied 
externally, local anesthesia. In due time drowsiness results, which 
soon passes into sleep ; the latter lasts from eight to twelve hours. 
On awakening, a slight dizziness, loss of appetite, and constipation 
are often experienced. Large doses of morphin produce a comatose 
condition ; all reflexes are abolished, the face looks sallow and 
cyanosed, the eyeballs are turned upward, and the pupils are con- 
tracted. The respiration becomes shallow, and is interrupted by 
the Cheyne-Stoke breathing. Respiration ceases entirely before 
the heart beat stops its final action. In poisoning with morphin, 
even when given hypodermically, it is often found in the stomach. 
The stomach should always be thoroughly washed, and the patient 
must be kept awake and in motion if at all possible. Artificial 
respiration, even after life seems to be extinct, should be persist- 
ently applied. The injection of full doses of strychnin is indi- 
cated. 

The continuous use of morphin readily leads to an addiction to 
the drug. Extreme care should be exercised in prescribing larger 
quantities of morphin for prolonged use, and under no condi- 
tions should the patient be allowed to administer a hypodermic 
injection to himself. Sufferers from persistent cases of facial neu- 
ralgia frequently become habitues of this poison. 

Morphin is the supreme analgesic, and will reduce the most 
persistent and apparently unbearable pain. It should not, how- 
ever, be used indiscriminately on account of the possibility of in- 
ducing morphinism. Morphin should always be substituted by 
some other analgesic if possible, and it should be used only in cases 
of absolute necessity. Pain arising from certain forms of acute 



338 PHARMACO-THERAPEUTICS. 

alveolar abscesses, difficult eruption of a lower third molar, etc., 
may call for its administration. Morphin is very beneficial in 
diseases of the respiration and the respiratory apparatus. Applied 
to an exposed pulp, either alone or combined with arsenic, mor- 
phin has no action. (See arsenic trioxid.) 

Aconite; Aconitum, U. S. P.; Aconiti Radix,. B. P.; Monk's 
Hood ; Wolfsbane ; Aconite Napel, F. ; Eisenhut, G. 

Source and Character. — It is the dried tuberous root of 
Aconitum napellus. Its principal constituent is the alkaloid 
aconitin. The latter is insoluble in water, but readily soluble in 
alcohol. 

Average Dose. — 1 grain (0.065 Gm.). 

Preparations. — 

Tincture of Aconite; Tinctura Aconiti, U. S. P., B. P. A hydro- 
alcoholic solution of the active constituents of aconite. Average 
dose, 10 minims (0.06 Cc). 

The strength of the tincture of aconite of the present U. S. P. 
(1905) has been reduced from 35 grams of aconite in 100 cubic 
centimeters (U. S. P. 1890) to 10 grams of aconite in 100 cubic 
centimeters. 

Therapeutics. — Aconite is principally employed in the form 
of the tincture. The alkaloid differs greatly with the soil on 
which the tuber is grown, and on account of its very poisonous 
nature is rarely employed internally. Aconite is a powerful poi- 
son; it slows and weakens the heart and circulation, and quickly 
paralyzes the respiratory centers. As it reduces the tempera- 
ture, it is quite in favor as a febrifuge, especially in children's 
diseases, with the older practitioners. Locally applied, tincture of 
aconite benumbs the terminations of the sensory nerves of the 
skin and the mucous membranes; hence its extensive use in den- 
tistry as a local anodyne. It deserves to be recommended in facial 
neuralgia in the form of a liniment or ointment, especially when 
combined with menthol. The addition of tincture of aconite to 
tincture of iodin, which is so very largely used in dentistry as an 
anodyne and a counterirritant, is of little practical value ; the offi- 
cial tincture merely dilutes the iodin solution. The aconite rep- 



ANODYNES. 339 

resented in this mixture is entirely too small to be of benefit, and, 
if a concentrated tincture (fluidextract) is used, the possibility 
of its quick absorption and subsequent untoward effects courts 
danger. 

Toxicology. — If a large dose of tincture of aconite is ab- 
sorbed, a peculiar feeling of warmth in the mouth and the throat 
is manifested. It is followed by a prickling and tingling sensa- 
tion, and accompanied by a profuse flow of saliva and frequent 
vomiting. Death results from paralysis of the respiratory centers. 
Emetics, strong coffee, and tea are indicated, together with general 
stimulants. 

Anodyne Compounds for Facial Neuralgia. 

fy Menthol. 5 j (4.0 Gm.) 

Chloroform. n*5 ij (8 Cc.) 

Tinct. aconiti ad flg j (30 Cc.) 

M. 

Sig. : Apply externally on the painful points of the face 
and cover with cotton. 

fy Aconitinse gr. ij (0.125 Gm.) 

Menthol. 5 ij (8.0 Gm.) 

Methyl, salicyl. A3 ij (8 Cc.) 

Lanolini ad 5 j (30.0 Gm.) 
M. f. unguentum. 

Sig. : Rub on the painful points of the face and cover 
with cotton. 

For Pericemental Disturbances. 

fy Tinct. aconiti A3 ij (8 Cc.) 

Tinct. iodi 

Chloroformi a A3 j (4 Cc.) 

M. 

Sig. : Dry the gum and apply over the affected tooth. 

(Buckley.) 

Atropin Sulphate; Atropine Sulphas, U. S. P., B. P.; 

(C 1T H 28 N0 3 ).H 2 S0 4 . 

It is the sulphate of an alkaloid obtained from Atropa bella- 
donna. It appears as a white crystalline powder, having a very 
bitter taste. It is very soluble in water and alcohol. Atropin is 
used in dentistry as a physiologic remedy for arresting or lessen- 



340 PHARMACO-THERAPEUTICS. 

ing secretions (see Sialogogues and Antisialogogues) , and as an 
anodyne; it is much inferior to aconite for the latter purpose. 
Its other important functions on the eye and central nervous sys- 
tem are of less importance for our present consideration. It is a 
very powerful poison. 

Average Dose. — y l60 grain (0.0004 Gm.). 

SEDATIVES. 

Sedatives (from sedate, to quiet) are drugs employed for the 
purpose of reducing irritability of the central nervous system. 
They affect motor and sensory centers alike. In their principal 
action, sedatives are closely related to general anesthetics. When 
administered in therapeutic doses they do not produce anesthetic 
effects; they possess only mild anodyne and hypnotic actions. 
Whenever the central nervous system becomes intensely irritated 
through external sources, or from factors which originate within 
the body, general excitement results, which is designated by the 
general term nervousness. Sedatives are indicated for these 
disturbances, and they usually subdue the state of excitement 
within a reasonably short time, while on the healthy individual 
they have apparently no effect. The most important representa- 
tive of this therapeutic group is bromin in the form of its alkali 
salts. It has been experimentally shown that the bromin salts will 
reduce irritability of the motor centers of the cerebrum without 
inducing anesthesia. Aside from bromin compounds, the ano- 
dynes and antipyretics are often prescribed in milder cases of 
nervousness. A few vegetable and animal drugs, which are char- 
acterized by their specific, intense, and frequently disagreeable 
odor — valerian, asafetida, castoreum, etc. — were in great favor as 
nerve sedatives with the older practitioners. So far no definite 
pharmacologic action has been attributed to these latter com- 
pounds. 

Sedatives frequently render valuable service in preparing a 
hypersensitive patient for a lengthy dental operation. It has been 
clinically demonstrated that the hypersensitiveness of the teeth, 
which in most cases is merely an expression of a general nervous 



SEDATIVES. 341 

irritation, may be materially reduced by an average dose of a well- 
defined sedative administered shortly before the operation begins. 
Schroder has shown (see Diagnosis of Diseases of the Pulp by the 
Electric Current) that 15 grains (1 Gm.) of chloral hydrate will 
within ten minutes increase the resistance of the tooth to the 
current very markedly. Recently Hecker 1 advocated bromural 
for the same purpose. The strain of a lengthy and painful dental 
operation may be much lessened by the judicious administration 
of a sedative, which enables 'both the patient and the operator to 
save much unnecessarily expended nerve force. 

Potassium Bromid; Potash Bromidum, U. S. P., B. P.; KBr; 
Bromure de Potassium, F. ; Bromkali, G. 

It forms colorless or white crystals, or a granular powder, having 
a strongly saline taste. It is soluble in 1.5 parts of water and in 
180 parts of alcohol. 

Average Dose. — 15 grains (1 Gm.). 

Sodium Bromid; Sodii Bromidum, U. S. P., B. P. ; NaBr. It 
forms colorless pr white crystals, or a granular powder, having a 
saline, slightly bitter taste. It is soluble in about 2 parts of water 
and 12.5 parts of alcohol. Average dose, 15 grains (1 Gm.). 

Ammonium Bromid; Ammonii Bromidum, U. S. P., B. P.: 
NH 4 Br. It forms colorless prismatic crystals or a white crystalline 
powder, odorless, and having a pungent, saline taste. It is soluble 
in about 1.5 parts of water and 12.5 parts of alcohol. Average 
dose, 15 grains (1 Gm.). 

Other bromids — the salts of lithium, calcium, and strontium, 
hydrobromic acid, and other bromin compounds — are used in 
therapeutics; their action depends principally on their bromin 
components. Bromin salts are best prescribed in solution, and 
should be taken largely diluted with water. The irritation result- 
ing from the injection of bromin salts into the tissues prohibits 
their application for such purposes. 

Bromural ; Alpha-monobrom-isovaleryl-urea ; CeH^PLOgBr. 

Bromural forms small white, almost tasteless, needles, which are 

readily soluble in hot water, but less soluble in cold water. It is 



1 Hecker: Dental Cosmos, 1909, p. 844. 



342 PHARMACO-THERAPEUTICS. 

a nerve sedative, and produces sleep, with apparently no side 
action on the circulation or respiration. It is best administered in 
5-grain (0.3 Gm.) tablets three times daily. 

Valerian; Valeriana, U. S. P.; Valerianae Radix, B. P. 

Valerian and its many galenic preparations have a wide repu- 
tation as nerve sedatives. Nervous and hysteric women are espe- 
cially partial to their use. 

Validol. It is the menthylester of valerianic acid, containing 
30 percent of free menthol. It is a clear, colorless liquid, having 
a peculiar odor and a slightly bitter taste. It is insoluble in water, 
but readily soluble in alcohol, ether, etc. It combines the action 
of valerian and menthol, and is used as an analeptic, antihysteric, 
and stomachic. Validol is much lauded in sea sickness, and is 
apparently of some value as a prophylactic in this dismal malady 
when taken at regular intervals in 5-drop doses mixed in a glass 
of Bordeaux wine. Average dose, 8 minims (0.5 Cc). 

CEREBRAL STIMULANTS. 

Cerebral stimulants (from stimulus, a goad) are drugs which 
physiologically excite the motor centers of psychologic activity. 
They are also known as excitants, or as analeptics (from analep- 
tics, to restore). The latter term is usually restricted to heart 
stimulants. In the excitement caused by artificial stimulation, 
other cerebral centers are also involved — as the respiration, the 
heart, the vasomotor centers, etc. It may be observed, however, 
that general excitement, which manifests itself in an increased 
physical activity, garrulity, etc., is not always the result of cerebral 
stimulation: often the reverse is the case — that is, a paralysis of 
the higher inhibiting centers. 

Caffein is the most pronounced representative of the cerebral 
stimulants; it causes physical excitement without being followed 
by depression. Cocain (See Local iVnesthetics), in its pure form 
or as the coca leaf, is freely used as a cerebral stimulant by the 
Indians of Bolivia and Peru, and by the negroes of the United 
States. On account of its poisonous nature it is not employed 
medicinally for these purposes. Certain substances, as strychnin. 



CEREBRAL STIMULANTS. 343 

etc.. increase the irritability of the centers of reflex stimulation to 
a marked degree, while other alkaloids have a special predilection 
for the tetanic centers in the brain and in the spinal cord. Alcohol, 
in its many modifications and administered in small doses, is a 
cerebral stimulant of importance, although many pharmacologists 
deny this characteristic effect, claiming that alcohol is a narcotic- 
In the hands of the clinician, however, alcohol in small doses 
proves to be a valuable stimulant, which is extensively used. The 
respiratory centers, the vasomotor center, and the heart may be 
easily excited by direct stimulation or by reflex action — as by the 
inhalation of ammonia vapors, faradic stimulation, slapping with 
wet towels, etc. Cerebral stimulants are indicated in fainting, in 
exhausting chronic diseases, in poisoning by anesthetics, etc. 

Hot strong infusions of coffee and tea are well-known cerebral 
stimulants : they do not contain nutritious substances. For a short 
time they may depress the feeling of hunger and increase mental 
and physical activity, which is often followed by a slightly in- 
creased appetite. In some respects large doses of caffein (coffee or 
tea) act antagonistic to those of alcohol; strong coffee and tea in- 
crease the mental faculties, and are often productive of insomnia, 
especially in nervous individuals, while large doses of alcohol 
stupefy and rather invite sleep. 

Alcohol (see Antiseptics of the Marsh Gas Series) as a cerebral 
stimulant is principally employed in the form of fermented liquors 
and wines, containing from 3 to 70 percent of pure ethyl alcohol. 
Alcohol in concentration of 65 percent or more precipitates 
albumin, and acts as a caustic. .The mucous membranes of the 
mouth and throat of those who are used to strong alcoholic drinks 
are not much affected by liquors containing 50 to 65 percent of 
pure alcohol (rum. arrack, etc.). while the unaccustomed suffer 
with a feeling of burning and coughing after their use. The opin- 
ions regarding the use of fermented liquors as cerebral stimulants 
differ widely ; it is impossible to definitely outline when alcohol is 
indicated for such purposes. The general consensus of opinions 
of experienced clinicians points to the fact that alcohol admin- 
istered in rational doses seemingly reduces the excitability of the 
patient caused by external or internal irritation. In certain 



344 PHARMACO-THERAPEUTICS. 

infectious diseases — septicemia, pyemia, etc. — the administration 
of alcohol in large quantities is apparently useful as a means of 
increasing the resistance of the body against the inviting foe by 
probably favorably influencing the formation of antitoxins. 
Again, alcohol in the form of whisky is lauded as a stimulant of 
the circulation, especially the heart; its usefulness under these 
conditions is referred to under Circulatory Stimulants. Whether 
alcohol is a nutrient in the true sense of the word is as yet not fully 
proved ; it is certain, however, that it inhibits the rapid disintegra- 
tion of the albuminous contents of the cells, especially -in lasting 
febrile diseases, and thereby acts as an indirect means of saving 
valuable bodily strength. Incidentally, it is often employed as a 
vehicle in the administration of nutritious substances — yolk of 
egg in the well-known form of egg-nog. The habitual use of 
liquors containing over 30 percent of alcohol, especially when 
taken into the empty stomach, causes chronic disturbances of the 
latter, which manifest themselves in catarrh, vomitus, etc. 

Caffein; Caffeina, U. S. P., B. P.; C 8 H 10 N 4 O 2 +H 2 O ; 
Cafeine, F. ; Koffein, G. 

Caffein is a feeble basic substance obtained from the dried seed 
of coffee, Coffea arabica, or the dried leaves of tea, Thea sinensis. 
It appears in long white, silky crystals, odorless, but having a bit- 
ter taste. It is soluble in about 46 parts of water, 45 parts of 
alcohol, and readily soluble in boiling water. 

Average Dose. — 1 grain (0.065 Gm.). 

Citrated Caffein; Caffeina Citrata, U. S. P.; Caffeinse Citras, 
B. P. It is a white powder, consisting of a weak chemic combina- 
tion of citric acid with caffein. It is soluble in about 25 parts of 
water. Average dose, 2 grains (0.125 Gm.). 

Effervescent Citrated Caffein; Caffeina Citrata Effervescens, U. 
S. P. ; Caffeinse Citras Effervescens, B. P. An effervescent powder, 
consisting of a mixture of citrated caffein with sodium bicarbonate, 
tartaric acid, and sugar. Average dose, 60 grains (4 Gm.). 

Whisky; Spiritus Frumenti, U. S. P.; Eau de Vie de 

GRANIS, F. ; KORNBRANNTWEIN, G. 

An alcoholic liquid obtained by the distillation of the mash of 



STOMACHICS AND DIGESTIVES. 



345 



fermented grain — as Indian corn, rye, wheat, barley, etc. It is 
an amber-colored fluid, having a distinctive odor and taste, and 
should contain from 44 to 55 percent by volume of absolute 
alcohol. 

Brandy; Spiritus Vini -Gallici, U. S. P., B. P.; Brandy; Cog- 
nac, F. ; Franzbranntwein, G. 
An alcoholic liquid obtained by the distillation of the fermented 
unmodified juice of fresh grapes. It is a pale, amber-colored fluid, 
having a distinctive odor and taste, and should contain from 46 to 
55 percent by volume of absolute alcohol. 

White Wine ; Vinum Album, U. S. P. ; Vin Blanc, F. ; Weiss- 

wein, G. 

It is the fermented juice of fresh grapes, and should contain 
from 8 to 15 percent by volume of absolute alcohol. 

Red Wine ; Vinum Rubrum, U. S. P. ; Vin Rouge, F. ; Rot- 

wein, G. 

It is the fermented juice of fresh red-colored grapes, and should 
contain from 8 to 15 percent by volume of absolute alcohol. 

The following table gives the list of the average alcoholic com- 
ponent of the more important fermented liquors. 

alcoholic component of the more important alcoholic beverages. 



Percent by volume. 

Lager beer 2 to 3.5 percent 

Export beer 3.5 to 4.3 percent 

Ale, porter, stout . 3 to 6 percent 

Moselle wine 7 to 8 percent 

Rhine wine 8 to 9 percent 

French red wine. . .7.5 to 9 percent 

Claret 8 to 14 percent 

Catawba 10 to 12 percent 

Sherry 14 to 18 percent 



Port 

Champagne, dry . . 10 to 
Champagne, sweet 9 to 

Cider 5 to 

German schnapps . 38 to 

Whisky 44 to 

Brandy 46 to 

Gin 45 to 

Rum 50 to 



Percent by volume. 

15 to 19 percent 
11 percent 
10 percent 
10 percent 
42 percent 
55 percent 
55 percent 
50 percent 
70 percent 



STOMACHICS AND DIGESTIVES. 

Stomachics (from stomachum, stomach) and digestives (from 
digere, to digest) form one of the many groups in pharmaco- 
therapeutics which can not be precisely defined. The remedies of 



346 PHARMACO-THERAPEUTICS. 

this group perform certain functions which beneficially influence 
the many duties of the stomach. The stomach has to fulfill a 
motor function — that is, its rhythmic peristaltic movements 
mixes the ingested food stuffs with its own secretions and then 
passes the liquefied material through the pylorus into the small 
intestines. The stomach secretes the gastric juice, consisting of 
pepsin, rennin, hydrochloric acid, inorganic salts, and water. The 
hydrochloric acid disintegrates the albumins and muscle fibers, 
and prepares them for the action of the pepsin. The latter dis- 
solves the albumin and changes the albuminates into proteoses and 
peptons. The rennin precipitates casein from the milk which has 
been taken into the stomach ; the casein is dissolved by the proteo- 
lytic action of the pepsin. The stomach wall absorbs only very 
few dissolved substances. Water or aqueous solutions, even if they 
contain easily diffusible substances, are not absorbed, while alcohol, 
alcoholic solutions, and volatile substances are' more readily 
absorbed. The hydrochloric acid component (0.02 percent) of 
the gastric juice has to perform another important function; it 
acts as a sterilizing medium of the contents of the stomach. Many 
of the swallowed bacteria, especially pathogenic germs, are 
promptly destroyed by this acid. The mucous membrane of the 
stomach may become anatomically altered, and many diseases — 
catarrh, ulcer, hemorrhage, etc. — may result, which incidentally 
lessen or inhibit its function. 

One or all of the enumerated functions of the stomach may be- 
come disturbed, and it is then the duty of the physician to readjust 
the disturbed faculties. Antiseptics are occasionally necessary to 
inhibit abnormal fermentation. Diluted hydrochloric acid, boric 
acid, or resorcinol in 1-percent solution are indicated. The latter 
two are especially useful when employed as lavage. Belching, 
which is caused by the presence of fatty acids as a result of abnor- 
mal fermentation, may be greatly relieved by mild antiseptics. 
Astringents are indicated to protect inflamed mucous surfaces, 
especially in ulcers of the stomach. Bismuth subnitrate alone or 
in combination with magnesia (milk of magnesia) is serviceable 
for such purposes. Pronounced astringent action is readily ob- 
tained with lavage of silver nitrate solution, 1:1,000. Acute or 



STOMACHICS AND DIGESTIVES. 347 

chronic catarrh is beneficially influenced by the neutral salts 
(sodium chlorid, etc.). Overproduction of hydrochloric acid in 
the stomach can be correctly determined only by a ehemic analysis 
of a test meal. It calls for mild antacids — sodium bicarbonate, 
calcined magnesia, and milk of magnesia. The latter preparation 
is preferably employed, as it incidentally neutralizes carbonic acid, 
which otherwise unnecessarily distends the stomach. If there is 
an insufficiency of hydrochloric acid, it is readily supplied by 
administering the well-diluted acid. The latter is preferably 
given either before meals to increase the appetite, or after meals to 
promote digestion. By reflex action the secretion of hydrochloric 
acid may be artificially increased; the simple bitter's — as gentian, 
columbo, dandelion, etc. — are administered for such purposes. 
The ferments present in the gastric juice — pepsin and rennin — 
may also be artificially substituted in case of need. Pepsin, prefer- 
ably in the form of its many solutions, or its vegetable substitute, 
papain, is indicated for the purpose. The various combined func- 
tions of the stomach may be increased in their total action by 
reflex stimulation. The simple bitters known as stomachics, 
digestives, aromatics, and by other titles, diluted alcohol in the 
form of wine or beer, and carbonated table waters are valuable 
reflex stimulants. The common habit of having table waters, 
wines, etc., "iced," especially when taken into the empty stomach, 
and too fast eating are largely responsible for the many forms of 
stomach diseases which are generically referred to as dyspepsia. 

Gentian ; Gentiana, U. S. P. ; Gentians Radix, B. P. ; Gen- 
tiane Jaune, F. ; Enzian, G. 

It is the root of Gentiana lutea; it contains a glucosid, gen- 
tiopicrin, a trace of tannic acid, and other bodies of less impor- 
tance. In the form of an extract, fluidextract, or tincture it is 
widely used as a bitter tonic. 

Average Dose. — 15 grains (1 6m.). 

Columbo; Calumba, U. S. P.; Calumb^ Radix, B. P.; 

COLUMBO, F. ; COLUMBOWURZEL, G. 

It is the root of Jateorhlza palmata; it contains columbin and 
columbinic acid, and is principally employed in the form of an 



348 PHARMACO-THERAPEUTICS. 

extract, fluidextract, tincture, cr infusion. It is used as a tonic, 
stomachic, and mild astringent. 

Average Dose. — 30 grains (2 Gm.). 

Dandelion ; Taraxacum, U. S. P. ; Taraxaci Radix, B. P. ; 
Lion's Tooth; Dent de Lion, F. ; Lowenzahn, G. 

It is the root of dandelion, Taraxacum officinale, and contains 
two neutral bitter substances. It is principally employed in the 
form of an extract, fluidextract, tincture, or the expressed juice. 
It is used as a bitter tonic and stomachic. 

Average Dose. — 120 grains (8 Gm.). 

Quassia; Quassia, U. S. P.; Quassia Lignum, B. P.; Bitter 
Ash ; Bitter Wood ; Quassie, F. ; Quassienholz, G. 

It is the wood of Picrasma excelsa, and contains several bitter 
substances which resemble each other closely and are known as 
quassins. In the form of an extract, tincture, or infusion it is 
used as a bitter tonic and febrifuge. 

Average Dose. — 7 1 / 2 grains (0.5 Gm.). 

Serpentaria ; Serpentaria, U. S. P. ; Serpentaria Rhizoma, 

B. P. ; Virginia Snake Root ; Couleuvree de Virgine, F. ; 

Virginia nische Schlangenwurzel, G. 

It is the rhizome and wood of Aristolochia reticulata, and con- 
tains a volatile oil, a bitter principle, and an alkaloid, aristolochin. 
It is usually employed in the form of a fluidextract, tincture, or 
infusion. 

Average Dose. — 15 grains (1 Gm.). 

Hops ; Humulus, U. S. P. ; Lupulus, B. P. ; Houblon, F. ; 

Hopfen, G. 

They are the dried strobiles of Humulus lupulus, and contain a 
volatile oil, a bitter, neutral substance, lupulin, and resins. Hops 
are employed in the form of a fluidextract, oleo-resin, tincture, or 
infusion, and are used as a tonic, carminative, diuretic, and exter- 
nally in the form of a poultice as an anodyne and hypnotic. 

Average Dose. — 30 grains (2 Gm.). 



STOMACHICS AND DIGESTIVES. 349 

rex in Hydrochloride It is a yellowish-white crystalline pow- 
der, soluble in 15 parts of water, with a bitter taste. It is prin- 
cipally administered in the form of a powder or as tablets as an 
appetizer and an antiemetic. Average dose. 5 grains (0.3 Gm.). 

Pepsin; Pepsinum, U. S. P.. B. P.: Pepsixe, F. : Pepsin, G. 

It is a proteolytic ferment obtained from the glandular layers 
of the fresh stomach of the healthy hog. and capable of digesting 
not less than 3.000 times its own weight of freshly coagulated 
albumin. It is a white or cream-colored amorphous powder, or 
thin, yellowish, translucent scales, free from any offensive odor, 
and having a slightly acid or saline taste. It is soluble in about 
50 parts of water, and its solubility is increased if the water is 
slightly acidulated with hydrochloric acid. Pepsin is usually 
administered during or after meals. 

Average Dose. — 1 grains (0.25 Gm.). 

Papain; Papayotin; Papoid; Vegetable Pepsin. It is the con- 
centrated, active principle of the juice of the fruit and leaves of 
the papaw. Carica papaya. It is a whitish hygroscopic powder, 
soluble in water and glycerin, and is used as a substitute for pepsin. 
Average dose. 4 .grains (0.25 Gm.). 

Pepsin and its substitute, papain, have been advocated as a 
means of digesting the dead dental pulp. Oakley Coles. Arkovy. 
and Harlan have recommended it for such purposes: it is rarely 
employed at present. 

Pancreatin; Pancreatinum, U. S. P.: Pancreatine Medici- 

xale. F. : Pancreatin, G. 

It is a mixture of enzymes which exist in the pancreas of warm- 
blooded animals, and is usually obtained from the fresh pancreas 
of the pig. It forms a yellowish or grayish-white amorphous pow- 
der, having a faint odor and a meat-like taste. It is slowly soluble 
in water, but insoluble in alcohol. It is given in powder, or in 
very weak acid or alkaline solution; it should never be given in 
combination with pepsin. Pancreatin digests albuminoids and 
converts starch into sugar, dextrin, or maltose. 

Average Dose. — 7 : 2 grains (0.05 Gm.) i 



350 PHARMACO-THERAPEUTICS. 

Aromatic Stomach Bitters. 

Gentian root 6 parts. 

European century herb 6 parts. 

Bitter orange peel 4 parts. 

Bitter orange apple 2 parts. 

Zedoary root 2 parts. 

Alcohol 65 parts. 

Water 35 parts. 

The drugs are coarsely powdered, macerated for a week in 
the diluted alcohol, and then filtered. 

Pepsin Paste. 

J$l Pepsin. gr. xv (1.0 Gm.) 

Acid, hydrochloric, dil. gtt. iv (0.25 Cc.) 

Aquae destil. q. s. to make a stiff paste 

This paste is packed into the pulp chamber in close con- 
tact with the dead pulp; it is sealed in and left undisturbed 
for a week. It will digest (liquefy) the dead pulp. 



EMETICS. 

Emetics (to vomit) are remedies which cause forcible expulsion 
of the contents of the stomach through the esophagus. They were 
much more frequently employed in former years than at present. 
Vomiting is a localized process; it is artificially, sometimes spon- 
taneously, produced to relieve an overfilled stomach or to remove 
poison. The use of the stomach tube has greatly lessened the sys- 
tematic administration of emetics of bygone days, and the tube 
should be employed whenever possible. Vomiting is partially a 
physiologic process ; it occurs very frequently and without further 
disturbances in infants and young children. The older we get, the 
less often we vomit, and the more we suffer from the accompany- 
ing disagreeable side effects. In the ruminants rechewing of the 
cud is a physiologic process, which is performed by these animals 
with apparently much pleasure. Many birds — -eagle, hawk, owl, 
crow, etc. — and many fishes — carp, pike, barbel, etc. — vomit the 
balled-up un digestible material after their meals, while the rodents 
never vomit. The physiologic act of vomiting is produced by an 
irritation of the vomiting centers in the fourth ventricle. The 
irritation is carried to these centers from the periphery — the 






EMETICS. 351 

mucous coat of the stomach and other organs of the abdominal 
cavity. The act of vomiting consists in a series of definite 
processes; a strong, positive pressure is brought on the abdomen, 
which contracts the abdominal muscles, and causes a negative 
pressure of the thoracic cavity. Incidentally the cardiac end of 
the stomach is opened, and its contents are suddenly forced into 
the esophagus. The muscles of respiration will also contract, and 
the resulting positive pressure forces the food from the esophagus 
into the mouth. During the process of vomiting large quantities 
of saliva and mucus are secreted by the glands of the mouth, 
pharynx, and esophagus, and probably also by those of the larynx. 
Vomiting always depresses the circulation. The preliminary 
psychic stage of vomiting is accomplished in man by an intensely 
disagreeable, sickening feeling known as nausea. The thought of 
certain food or of loathsome things, or even listening to stories 
which are nauseating, may produce this feeling of intense disgust. 
Emetics act by reflex action or by direct stimulation. By reflex 
action — irritation of the pharynx, the stomach, the intestines, the 
uterus, etc. — vomiting is easily produced. The direct stimulation 
of the centers of vomiting may result from anemia of the brain, 
pressure on the brain, and from chemic substances. The metallic 
salts and ipecac produce only reflex action , they have to be in- 
gested into the stomach to create vomiting, and will not act when 
injected hypodermically or subcutaneously. Apomorphin acts by 
direct stimulation of the vomiting centers, and produces much 
prompter results when injected hypodermically. 

Emetics are indicated to remove foreign bodies from the 
esophagus or the stomach. If a foreign body has lodged in the 
trachea and is not removed by a coughing spell, pressure produced 
by spasmodic vomiting may occasionally be helpful in its dis- 
lodgement. This procedure may be of some service in case a tooth 
has fallen into the upper trachea during its extraction. Poisons 
which have entered the stomach should be removed as .quickly as 
possible to prevent absorption. While lavage of the stomach with 
the stomach tube is the correct procedure for such treatment, 
emetics are often of great assistance. Occasionally an overloaded 
stomach needs the quick removal of its contents. As Livy tells 



352 PHARMACO-THERAPEUTICS. 

us, the peacock feather was used for such purposes by the Roman 
slaves, especially during the reign of the emperors, to tickle the 
pharynx of their masters after a lucullic feast. Emetics are also 
of some service in aiding the therapeutic action of expectorants. 
The false membranes of croup may be forcibly removed by induc- 
ing vomiting, which incidentally produces a helpful increased 
secretion of the mucous membrane of the pharynx and larynx, 
and probably of the upper bronchi. Emetics are counterindicated 
in aneurysms, in pulmonary tuberculosis, in the senile, and in the 
last stages of pregnancy. 

Antimony and Potassium Tartrate; Antimonii et Potassii 
Tartras, U. S. P. ; Antimonium Tartaratum, B. P. ; Tartar 
Emetic; Tartre Stibie, F. ; Brechweinstein, G. 

It forms colorless, transparent crystals, or a white granular 
powder, without odor, and having a sweetish and afterward dis- 
agreeable metallic taste. It is soluble in 17 parts of cold water and 
insoluble in alcohol. 

Average Dose. — y 2 grain (0.03 Gm.). 

Wine of Antimony ; Vinum Antimonii, U. S. P., B. P. Four 
parts tartar emetic dissolved in 1,000 (875, B. P.) parts of white 
wine. Average dose, 15 minims (1 Cc). 

Copper Sulphate; Cupri Sulphas, U. S. P., B. P. -As an emetic 
it is given in 2 to 4-grain (0.13 to 0.25 Gm.) doses, dissolved 
in a glass of water. 

Zinc Sulphate; Zinci Sulphas, U. S. P., B. P. As an emetic 
it is given in 15-grain (1 Gm.) doses, dissolved in a glass of water. 

Mercury Subsulphate; Hydrargyri Subsulphas Flavus; 

Turpeth Mineral. 

A heavy lemon-yellow powder, odorless and almost tasteless. It 
is only partially soluble in water. 

Average Dose. — 2 grains (0.13 Gm.) stirred in water. 

Apomorphin Hydrochlorid ; Apomorphin^e Hydrochloridum, 
U. S. P., B. P.; C 17 H 17 N0 2 .HC1. 

It is a grayish-white crystalline substance, odorless, and having 



CATHARTICS. 353 

a slightly bitter taste. It is very soluble in water, turning green 
or even black when kept in solution. 

Average Dose. — 1 / 10 grain (0.005 Gm.) hypodermically. 

Ipecac ; Ipecacuanha, U. S. P., B. P. ; Racine Bresilienne, F. ; 

Brechwurzel, G. 

It is dried root of Cacephselis ipecacuanha. The powdered root, 
stirred in water, is used as an emetic. 

Average Dose. — 15 grains (1 Gm.). 

Syrup and wine of ipecac are also used as emetics. 

In cases of emergency a tablespoonful of powdered mustard 
stirred in a cupful of warm water, a teaspoonful of salt dissolved 
in a glass of hot water, a few grains of alum dissolved in a glass of 
water, or hot water alone may be tried. They all irritate, more 
or less, the mucous lining of the stomach (except the hot water, 
which produces nausea) and they act then as emetics. 

CATHARTICS. 

Cathartics, commonly known as physic, are remedies used 
for the purpose of unloading the bowels per anum — defecation. 
They werejused much more freely in olden times ; in fact, to take 
medicine internally was at one time almost synonymous with tak- 
ing a physic. The term physic has been used, and is, to some 
extent, employed even at present, to indicate the art of medicine 
and of therapeutics. 

"With the progress of medical knowledge quite a number of 
specific terms have been created to designate the many sub- 
divisions of this large group. The Greeks spoke of cathartics and 
the Romans of purgatives, both meaning to clean up, when they 
referred to drugs which were employed to free the body of diseased 
juices and accumulated feces. Again, the term evacuant, to 
remove the feces, is used, while aperient indicates to open the 
bowels. A drastic, to force through, is a powerful cathartic, while 
a laxative is a drug which means softening of the fecal matter. 
Carminatives are employed to remove gases from the bowels. The 
flow of bile is increased by a cholagogue, and to produce watery 



354 PHARMACO-THERAPEUTICS. 

evacuations hydragogues are administered. The term saline indi- 
cates a cathartic consisting of neutral salts of the metals of the 
alkalies or alkaline earths. 

The formation of the feces is the result of the accumulation of 
nonabsorbable remnants of the mixed foodstuffs — cellulose, ani- 
mal fibrous tissue, cartilage, etc. With the aid of the glandular 
secretions, ferments, and intestinal bacteria, putrefaction is pro- 
duced, which results in the formation of carbon dioxid, marsh gas, 
sulphuretted hydrogen, ptomains, and the many other products of 
decomposition. The fecal matter remains in the lower intestines 
for about fifteen hours ; through the absorption of fluid the formed 
feces are produced, which finally are expelled by peristalsis, in- 
volving a complicated process of nervous impulses. The inhibition 
of normal peristalsis produces acute and chronic constipation 
(obstipation) ; to relieve this condition, cathartics are indicated. 
In acute constipation cathartics may be taken with impunity, 
while in chronic constipation other means — as regulation of the 
diet, etc. — are to be preferred to the continued administration of 
cathartics. In acute catarrh of the bowels, and sometimes in acute 
poisoning, cathartics are of service. Obesity is occasionally favor- 
ably influenced by the judicious administration of cathartics. 
Cathartics are not indicated in peritonitis, sutures, or other surgical 
interferences with the bowels, in extreme general weakness, and in 
hemorrhage of the bowels. 

The action of cathartics depends very much on the nature of the 
remedy employed. Direct irritation of the smooth muscular coat 
of the bowel is rarely accomplished; the great bulk of cathartics 
act by indirect irritation of the motor ganglia of the intestines, 
which results in an increased peristalsis. The quick removal of the 
feces by these cathartics prevents their formation into a solid mass. 
The resultant stool is usually of a fluid nature. Vegetable materials 
which are rich in pectin — manna, tamarinds, honey, jellies, pre- 
serves, etc. — form colloidal solutions in the intestines, and retain 
large quantities of water, and by their softening influence act as 
mild laxatives. The various alkali salts — the sulphates, phos- 
phates, and tartrates — which are diffusible only with difficulty, 
and the salts of the alkaline earth metals — magnesium carbonate, 



CATHARTICS. 355 

sulphate, etc. — act in a somewhat similar manner; incidentally 
they are mild irritants. The salines retain in the bowel the water 
of their own solution ; by osmosis they abstract fluid from the sur- 
rounding blood and lymph tissues until they become isotonic with 
the body fluids, and by the increased bulk, fluidity, and peristaltic 
movement produce copious stools. The readily diffusible salts — 
sodium chlorid, etc. — do not retain the water of their solution, and 
are easily absorbed by the bowel. Certain mild cathartics act by 
indirect stimulation of the motor ganglia, which is caused by their 
bulky mass — coarse bread, corn bread, pumpernickel, regulin. 
Dangerous irritation, followed by severe inflammation and annoy- 
ing tenesmus, are often caused by drastics — croton oil, jalap, 
colocynth — and are rarely employed at present. 

Cathartics are convenientlv divided into vegetable cathartics and 
saline cathartics; sulphur and calomel occupy an exempted posi- 
tion among the cathartics. 

Vegetable Cathartics. 

Rhubarb; Rheum, U. S. P.; Rhei Radix, B. P.; Rhubarbe, F. ; 

Rhabarber, G. 

It is the dried rhizome of Rheum officinale and other species. 
It is principally administered as an extract, nuidextract, or tincture. 
Average Dose. — 15 grains (1 6m.). 

Aloes; Aloe, U. S. P.; Aloe Barbadensis, B. P.; Aloe, F., G. 

It is the inspissated juice of the leaves of Aloe vera and other 
species. It is principally administered in its purified form as an 
extract, tincture, or wine. 

Average Dose. — 4 grains (0.25 Gm.). 

Cascara Sagrada; Rhamnus Purshiana, U. S. P.; Cascara 

S AGRA DA, B. P. 

It is the dried bark of Rhamnus purshiana. It is principally 
administered as a fluidextract, tincture, or aromatic syrup. 
Average Dose. — 15 grains (1 Gm.). 



356 PHARMACO-THERAPEUTICS. 

Frangula ; Frangula, U. S. P. ; Buckthorn ; Ecorce de Bouro- 
dine, F. ; Faulbaumrinde, G. 

It is the dried bark of Rhamnus frangula. It is principally 
administered as a fluidextract or tincture. 
Average Dose. — 15 grains (1 Gm.). 

Colocynth; Colocynthis, U. S. P.; Colocynthidis Pulpa, 
B. P. ; Coloquinte, F. ; Koloquinten, G. 

It is the peeled dried fruit or pulp of Citrullus colocynthis. It 
is best administered as an extract in pill form. 
Average Dose. — 1 grain (0.06 Gm.). 

Jalap; Jalapa, *CJ. S. P., B. P.; Jalap Tubereux, F. ; Jalap- 

PENKNOLLEN, G. 

It is the dried tuberous root of Exogonium purga. It is prin- 
cipally employed as a powder, extract, or tincture. 
Average Dose. — 15 grains (1 Gm.). 

Podophyllum; Podophyllum, U. S. P.; Podophyli Rhizoma, 
B. P. ; Mandrake Root ; Vegetable Calomel; Podophyllum, 
F.,G. 

It is the dried rhizome of Podophyllum peltatum. It is prin- 
cipally administered as an extract or resin in pill form. 
Average Dose. — 7 1 / 2 grains (0.5 Gm.). 

Senna ; Senna, U. S. P. ; Senna Alexandrina, B. P. ; Feuilles 
de Sene, F. ; Sennesblatter, G. 

The dried leaflets of Cassia acuiifolia. Senna is principally 
administered in powder form or as an infusion. 

Average Dose. — 60 grains (4 Gm.). 

Tamarind; Tamarindus, U. S. P., B. P.; Figs, Ficus, U. S. P., 
B. P.; Prunes, Prunum, U. S. P., B. P. They contain sugar and 
pectin in variable quantities, and are mild laxatives. 



CATHARTICS. 357 

Castor Oil; Oleum Ricini, U. S. P., B. P. ; Huile de Ricin, F. ; 

Rictnusol, G. 

It is the fixed oil expressed from the seeds of Ricinus communis. 
Average Dose. — 4 nuidrams (16 Cc.) . 

Croton Oil; Oleum Tiglii, U. S. P.; Oleum Crotonis, B. P.; 
Huile de Croton Tiglium, F. ; Krotonol, G. 

It is a fixed oil, expressed from the seeds of Croton tiglium. 
Average Dose. — 1 minim (0.05 Gm.). 

Saline Cathartics. 

Sodium Phosphate; Sodii PHOsniAs, U. S. P.. B. P.; Na,HP0 4 
+12H 2 0; PnosriiADE de Soude, F. ; Natriumphosphat, G. 

It appears in large, colorless crystals, odorless, and having a 
saline, cooling taste. It is soluble in about 5.5 parts of water and 
almost insoluble in alcohol. Sodium phosphate is best admin- 
istered in the compound solution of sodium phosphate, U. S. P., 
or as the effervescent sodium phosphate, U. S. P. 

Average Dose. — 30 grains (2 Gm.). 

Sodium Sulphate; Sodii Sulphas, U. S. P.. B. P.; Na 2 S0 4 
-flOIToO; Glauber's Salt; Sal de Glauber, F. ; Glauber- 
salz, G. 

It appears in large, colorless crystals, odorless, and having a 
saline taste. It is soluble in about 3 parts of water and almost 
insoluble in alcohol. 

Average Dose. — 240 grains (16 Gm.). 

Magnesium Sulphate: Magnksii Sulphas. U. S. P.. B. P.; 
MgS0 4 -j-7FLO; Epsom Salt; Sel d'Epsom, F. ; Bittersalz, G. 

It appears in small, colorless needles, without odor, and having a 
cooling, saline, and bitter taste. It is soluble in 1 part of water 
and almost insoluble in alcohol. It is best administered as the 
effervescent magnesium sulphate. U. S. P., B. P. 

Average Dose. — 240 grains (16 Gm.). 



358 PHARMACO-THERAPEUTICS. 

Solution of Magnesium Citrate; Liquor Magnesii Citratas, U. S. 
P. It is a solution of magnesium citrate, with an excess of citric 
acid, to which potassium bicarbonate is added. The solution must 
be kept tightly corked, and effervesces when poured from the 
bottle. Average dose, 12 fluidounces (360 Cc). 

Potassium Bitartrate ; Potassii Bitartras, U. S. P. ; Potassii 
Tartras Acidus, B. P.; KHC 4 H 4 6 ; Cream of Tartar; 
Creme de Tartare, F. ; Weinstein, G. 

It is a white, gritty powder, odorless, and has a pleasant, 
acidulous taste. It is soluble in about 200 parts of water and 
almost insoluble in alcohol. 

Average Dose. — 30 grains (2 Gm.). 

Potassium Citrate; Potassii Citras, U. S. P., B. P.; K 3 C 6 H 5 7 
+HoO ; Citrate de Potasse, F. ; Kaliumcitrat, G. 

It is a white, granular powder, odorless, and having a cooling, 
saline taste. It is soluble in about 0.5 part of water and almost 
insoluble in alcohol. It is best administered as effervescent potas- 
sium citrate, U. S. P. 

Average Dose. — 15 grains (1 Gm.). 

Potassium and Sodium Tartrate; Potassii et Sodii Tartras, U. S. 
P. ; Soda Tartarata, B. P. ; KNaC 4 H 4 6 +4H 2 ; Rochelle Salt; Sel 
de Seignette, F. ; Seignettesalz, G. It is a white powder, odorless, 
and having a cooling, saline taste. It is soluble in about 1.2 parts 
of water and almost insoluble in alcohol. Average dose, 120 grains 
(8Gm.). 

Compound Effervescing Powder; Pulvis Effervescens Com- 
positus, U. S. P. ; Pulvis Sodse Tartaratse Effervescens, B. P. ; 
Seidlitz Powder; Poudre de Sedlitz, F. ; Sedlitz Pulver, G. This 
powder is made up in two papers, blue and white; the blue one 
contains a mixture of 31 parts of sodium bicarbonate and 93 parts 
of potassium and sodium tartrate, and the white paper contains 
tartaric acid — 160 grains (10.4 Gm.) of Rochelle salt to 38 grains 
(2.25 Gm.) of tartaric acid. When the powders are dissolved 
separately in water and the solutions are mixed, the tartaric acid 



CATHARTICS. 359 

acts on the sodium bicarbonate and releases carbonic acid, with 
effervescence. 

Sulphur, Washed ; Sulphur Lotum, U. S. P. ; Sulphur Sub- 
limatum, B. P. ; Washed Flowers of Sulphur ; Soufre Lave*, 
F. ; Geretnigte Schwefelblumen, G. 

It is prepared by washing sublimed sulphur with water and 
ammonia. It is a fine, yellow powder, insoluble in water and 
slightly soluble in alcohol. 

Average Dose. — 60 grains (4 Gm.). 

Mercurous Chlorid, Mild; Hydrargyri Chloridum Mite, U. 
S. P. ; Hydrargyri Subchloridum, B. P. ; HgCl ; Calomelas ; 
Calomel, E., F., G. 

It is a white, heavy, impalpable powder, odorless and tasteless; 
insoluble in alcohol, water, and ether. It is incompatible with 
bromids, iodids, sulphates, sulphids, carbonates, limewater, alka- 
lies, ammonia, cocain, etc. It is best administered in powder 
form. 

Average Dose. — 2 grains (2.125 Gm.). As an alterative it is 
given in "broken" doses, 1 / 5 grain (0.01 Gm.) every two hours, 
followed by a saline cathartic. 

Mass of Mercury; Massa Hydrargyri, U. S. P. ; Blue Mass; Blue 
Pill. It is prepared by rubbing together metallic mercury with 
honey of rose, glycerin, althaea, and licorice until the globules of 
mercury are invisible under a lens magnifying ten diameters. 
Blue mass contains about 33 percent of mercury. It is admin- 
istered in pill form. Average dose, 4 grains (0.25 Gm.). 

Pur gen. It is phenolphthalein, which is so widely used as an 
indicator by coloring the solution red when brought in contact 
with alkalies. It acts as a mild laxative by irritating the bowels. 
It is best administered in tablet form, and should be thoroughly 
chewed and followed by a tumblerful of water. Average dose, 2 
grains (0.125 Gm.). 

Solutions of potassium, sodium, magnesium sulphate, and other 
alkaline salts in the form of bitter waters are much employed as 
mild laxatives. The more important natural mineral waters are 



360 PHARMACO-THERAPEUTICS. 

Hunyady-Janos, Carlsbad, Friedrichshall, Sedlitz, etc. These 
waters are principally drank in the early morning on an empty 
stomach. 

Saline Cathartic Solution. 

Ifc Magnesii sulphatis gj(30.0Gm.) 

Acid, sulphur, dil. gtt. xv (1 Cc.) 

Syr. limonis fl^ j (30.0 Cc.) 

Aquae ad fl^ iv (120 Cc.) 
M. 

Sig. : Tablespoonful in a glassful of water every three 
hours. 

Tonic Laxative. 

Ifc Tinct. nuc. vomic. gtt. xv (1 Cc.) 

Fluidextract. rhamni pursh. 

aromatic. fl^ j (30 Cc.) 

Syr. limonis ad fl^ ij (60 Cc.) 

M. 

Sig. Half a teaspoonful every two hours. 



CIRCULATORY STIMULANTS AND 
DEPRESSANTS. 

Drugs which are employed for the purpose of stimulating the 
circulation are known as circulatory stimulants, and they are some- 
times referred to as vasoconstrictors, while drugs which depress 
the circulation are spoken of as circulatory depressants or vaso- 
dilators. Those drugs which exercise a tonic influence on the 
heart are known as analeptics. 

Every organ of the body requires for its undisturbed function 
an uninterrupted rich supply of continuously renewed blood. The 
blood is inclosed in a system of elastic tubes — the arteries and 
veins — and the heart. The latter exercises the double function of 
a muscular suction and pressure pump, and by rhythmic con- 
traction and relaxation produces circulation* The blood flows 
through the heart in the direction of the valves, which open only 
toward the arteries. The heart is divided into two halves, and 
each half into two chambers — the auricle and the ventricle; the 
various dividing walls are provided with a number of valves. The 



CIRCULATORY STIMULANTS AND DEPRESSANTS. 361 

four chambers of the heart are essential for the proper sucking 
and pumping of the blood from the veins into the arteries. The 
rhythmic contraction and relaxation constitutes the heart cycle; 
the contraction of the auricular musculature constitutes the 
auricular systole — it forces the blood into the ventricles. The lat- 
ter are now filled completely with blood (its back flow being pre- 
vented by the closure of the tricuspid and mitral valves) , and, as 
soon as the inner pressure of the ventricles is above that of the 
pulmonary artery and the aorta, the semilunar valves open and the 
blood is ejected into the arteries by the ventricular systole. A 
period of rest and relaxation of ventricles and auricles now fol- 
lows, which constitutes the auricular and ventricular diastole. 
The heart beats about seventy-two times a minute, and each cycle 
of the heart occupies about 0.8 seconds. 

When the normal functions of the circulation are disturbed and 
the heart has to perform an increased amount of labor, nature has 
fortunately provided for this emergency by increasing the diam- 
eter of the fibers of the heart muscle, and thereby hypertrophy of 
the heart is established. The heart muscle may carry on this in- 
creased work for years, provided the patient avoids any undue 
exertion, without materially interfering with his welfare; it com- 
pensates the weak heart. To relieve or mitigate this compensa- 
tion, digitalis is the supreme remedy. It performs two functions 
— it slows the heart beat and increases the arterial pressure. 
Strophanthus, especially its g-alkaloid, has a somewhat similar 
action as digitalis. 

Occasionally it is necessary to quickly overcome an acute weak- 
ness of the heart — "heart failure.'' A direct stimulation is best 
accomplished with caffein, camphor, and alcohol, or ether; to 
insure their prompt action, they should be injected hypoder- 
mically, except caffein. 

For the purpose of increasing the activity of the vasomotor 
centers, which results in an increase of the blood pressure, stim- 
ulants are administered. They act by direct or by reflex action. 
The most powerful direct stimulation is produced by the absence 
of oxygen from the inspired air; this procedure is not employed 
therapeutically. The principal drugs employed for such purpose 



362 PHARMACO-THERAPEUTICS. 

are strychnin and, to some extent, atropin. Strychnin acts prin- 
cipally on the vasomotor centers of the medulla oblongata; it 
increases the blood pressure and the heart beat becomes slower. 
To insure quick action, strychnin is preferably administered by 
hypodermic injection. As an antidote in intoxication with 
paralyzing poisons — general anesthetics, opium and its salts, 
chloral hydrate — it acts as a powerful excitant. Atropin in small 
doses increases the pulse rate as a result of its inhibitory influence 
on the vagi nerves; it apparently antagonizes the action of 
morphin, and is much lauded as an antidote in morphin poison- 
ing. 

Paralysis, or, rather, diminished activity of the vasomotor cen- 
ters, is principally accomplished by the administration of the 
nitrites. Certain halogen substitution compounds — chloroform, 
chloral hydrate, etc. — have a pronounced paralyzing influence on 
the nervous system. Their action on the vasomotor centers is too 
severe, however, and consequently they are not used for such pur- 
poses. The nitrites dilate the peripheral vessels, especially those 
of the face and in the brain, and they increase the heart beat. 
Amyl nitrite and nitroglycerin are the principal representatives of 
this group. The vessel wall may be directly influenced by certain 
drugs, which are applied locally, or they may act by internal 
administration through the blood. The dilation or contraction of 
the vessel wall is the result of the action of the drug on the 
muscle fibers. Dilation of vessels is quickly obtained by ex- 
ternally applied irritants (see Irritants and Counterirritants) , 
while contraction of the vessel is the direct sequence of the appli- 
cation of certain astringents. (See Astringents.) A few drugs 
exhibit specific action as vasoconstrictors without possessing all 
the functions of an astringent, The two typical representatives 
of locally applied vasoconstrictors are cocain and the extract of the 
suprarenal gland. Cocain is principally used as a local anesthetic. 
Its vasoconstrictor side action is a valuable factor in the produc- 
tion of local anesthesia, (See Local Anesthesia.) The extract of 
the suprarenal gland, on account of the ready decomposition of its 
solution, is not used therapeutically. The hydrochloric salt of its 
alkaloid or its synthetic sabstitutes are the principal pharmaceutic 



CIRCULATORY STIMULANTS AND DEPRESSANTS. 363 

preparations employed for such purposes. Ergot and golden seal 
( Hydrastis), or their alkaloids, are principally administered inter- 
nally for the purpose of powerfully contracting the muscular coat 
of the uterus ; both drugs seem to possess a specific affinity for the 
smooth muscle fibers of this organ. Styptol and stypticin, which 
are both chemically related to hydrastin, are important local and 
internal vasoconstrictors; their functions have been referred to 
under Hemostatics and Styptics. 

Digitalis; Digitalis, U. S. P.; Digitalis Folia, B. P.; Fox- 
glove ; Feuilles de Digitale Pourpree, F. ; Fingerhut, G. 

They are the dried leaves of Digitalis purpurea, collected from 
plants of the second year's growth. Digitalis is preferably admin- 
istered in the form of an infusion ; the extract and the tincture are 
claimed to be less effective. The alkaloids of digitalis are uncer- 
tain in their action. 

Average Dose. — 1 grain (0.06 Gm.). 

Strophantus ; Strophanthus, U. S. P. ; Strophanthi Semina, 
B. P. ; Strophantus, F., G. 

It is the ripe seed of Strophanthus Kombe, and is preferably 
administered as the tincture. The alkaloid of strophanthus 
(strophanthinum, U. S. P.) varies much in its composition. 
G-strophanthinin is a reliable preparation. 

Average Dose. — 1 grain (0.06 Gm.). 

Strychnin Sulphate; Strychnine Sulphas, U. S. P.; 
(C 21 H 22 N 2 2 ) 2 .H 2 S0 4 -f 5H 2 0; Sulfate de Strychnine, F. ; 

SCHWEFELSAURES STRYCHNIN, G. 

It is the sulphate of the alkaloid strychnin, prepared from 
Strychnos nux-vomica. It appears in colorless crystals, or as a 
white crystalline powder, odorless, and having an intensely bitter 
taste. It is soluble in about 31 parts of water and 65 parts of 
alcohol. Strychnin or its salts are intensely poisonous. 

Average Dose. — y 64 grain (0.001 Gm.). 

Strychnin Nitrate; Strychninse Nitras, U. S. P. ; Strychnin 
Hydrochlorid; Strychninse Hydrochloridum, B. P. They are em- 



364 PHARMACO-THERAPEUTICS. 

ployed practically for the same purpose and in the same dose as 
strychnin sulphate. 

Amyl Nitrite; Amylis Nitris, U. S. P.; Amyl Nitris, B. P.; 
Azotite d' Amyl, F. ; Amylnitrit, G. 

It is a liquid, containing about 80 percent of amyl nitrite. It 
appears as a yellowish liquid, having a peculiar, ethereal, fruity 
odor and a pungent, aromatic taste. It should be kept in her- 
metically sealed glass bulbs in a cool and dark place. Small glass 
"pearls" containing from 2 to 5 drops of amyl nitrite are now 
procurable. When needed, a capsule is broken in a napkin and 
held before the patient's face. "Spirets" are small glass capsules 
containing 5 drops of amyl nitrite ; they are wrapped in lint, and 
when used they are crushed between the fingers. 

Average Dose. — 3 minims (0.02 Cc). 

Spirit of Nitroglycerin; Spiritus Glycerylis Nitritis, U. 
S. P.; Liquor Trinitrini, B. P. ; Spirit of Glyceryl Tri- 
nitrate; Spirit of Nitroglycerin; Spirit of Glonoin. 

It is an alcoholic solution, containing" 1 percent by weight of 
glyceryl trinitrate. It is a clear, colorless liquid, having the odor 
and taste of alcohol; even small doses produce violent headache. 
Glyceryl trinitrate is also marketed in tablet form; they readily 
deteriorate. The solution must be handled with extreme care to 
avoid explosion. 

Average Dose. — 1 minim (0.05 Cc). 

Desiccated Suprarenal Glands; Glandule Suprarenalis 
Sicoe, U. S. P.; Glands Surrenales Desseche'es, F. ; 
Getrocknete Nebenniere, G. 

Source and Character. — They are the suprarenal glands of 
the sheep or ox, freed from fat, and cleaned, dried, and powdered. 
They form a light yellow-brown amorphous powder, having a 
slight, characteristic odor, and are partially soluble in water. The 
powdered glands or their extract are rarely used at present ; their 
isolated active principle has superseded the cruder preparations. 
The alkaloid is known as adrenalin, epinephrin, suprarenin, etc., 



CIRCULATORY STIMULANTS AND DEPRESSANTS. 365 

and is employed as a 1:1,000 solution. The solutions are pre- 
served with small quantities of chloretone, thymol, etc. Adrenalin 
solutions do not keep well, and on exposure to air are oxidized and 
quickly destroyed; this latter process is hastened by diluting the 
solutions. Recently an artificial substitute has been introduced, 
and is known as synthetic suprarenin. Chemically it is the 
dioxyphenylethanolmethylamin hydrochlorid, or, briefly, the 
methylaminoalcohol. In its chemic, physiologic, and physical 
properties, synthetic suprarenin is strictly identical with the prod- 
ucts obtained from the adrenal glands, except that it is optically 
inactive. It is a chemically pure body, which does not vary in its 



A#^^ 



A/W 




Figure 49. 



Tracing the Blood Pressure under Synthetic Suprarenin. One milligram of the suprarenin 
hydrochlorid solution, 1:1,000, was injected at a into the carotid artery of a dog. (Abderhalden- 
Muller.) 

composition, and consequently it is superior to the product of the 
natural gland. (See Active Principle of the Suprarenal Capsule.) 

Average Dose of Adrenalin Hydrochlorid. — 1 / 100 o grain 
(0.00006 Gm.). 

Average Dose of Adrenalin. Hydrochlorid Solution, 
1:1,000.-1 minim (0.05 Cc). 

Therapeutics. — When adrenalin, even in very minute doses, 
is injected into the circulation of an animal, it causes a quick and 
powerful rise of blood pressure, with a strengthening of the heart 
beat. In a few minutes the increased pressure passes off slowly. 
No other known drug will produce a similar effect. Local applica- 



366 PHARMACO-THERAPEUTICS. 

tion on mucous surfaces or hypodermic injection of adrenalin 
solution produces a pronounced anemia within the affected area. 
Its continuous application causes a peculiar thickening of the ves- 
sel walls, which results in a degeneration of their muscular coat. 
Adrenalin solutions are locally applied to control small hemor- 
rhages, or by injection to produce anemia of the field of operation. 
Combined with cocain or novocain, it restricts the action of these 
local anesthetics to the involved area, thus lessening their absorp- 
tion and thereby increasing their action, and incidentally lessen- 
ing their poisonous effects. (See Local Anesthesia.) 

The internal administration of adrenalin, with the hope of act- 
ing through the blood after being absorbed, is useless; no effect 
will follow its absorption into the circulation. Adrenalin is of 
benefit in hay fever, in epistaxis, and in small hemorrhages from 
the mouth, nose, ear, etc. The quantity necessary for hypodermic 
injection is extremely small; one minim of 1:1,000 solution, 
diluted with a cubic centimeter of an isotonic anesthetic solution, 
is amply sufficient for the purpose, and 5 minims constitute the 
maximum dose of a single injection, which should not be exceeded. 

Caffein, camphor, validol, alcohol, and ether have been referred 
to under Cerebral Stimulants. 

Camphor Solution for Hypodermic Injection. 

T$l Camphorae 3 ss ( 2 -° Gm.) 

iEtheris fl^ j (30 Cc.) 

M. 
*Sig. : A cubic centimeter injected in cases of collapse. 

RESPIRATORY STIMULANTS AND 
DEPRESSANTS. 

Respiration is divided into external and internal respiration. 
External respiration is carried on by the lungs; it consists 'n the 
absorption of oxygen and the giving off of carbon dioxid by the 
blood when it passes through the lungs. Internal respiration is 
concerned with the interchanges of oxygen and carbon dioxid by 
the capillaries and the tissue cells. The apparatus connected with 
respiration consist of the nose, naso-pharynx, trachea, bronchi, 



RESPIRATORY STIMULANTS AND DEPRESSANTS. 367 

bronchioli, and the alveoli of the lungs. By the prolonged 
absence of oxygen and the increase of carbon dioxid the centers of 
respiration become paralyzed. The normal rhythmic movements 
of the latter arc regulated by certain ganglia located within these 
centers. Most of the inhaled oxygen is chemically bound to the 
hemoglobin, and only a small part is physically dissolved in the 
blood. Carbon dioxid is always present in the air in small quan- 
tities ( 3 / 100 percent) ; when this amount is materially increased,, 
the air becomes "fetal." The exhaled air of man or animal is not 
poisonous, provided it does not contain too large quantities of 
carbon dioxid. Pure carbon dioxid is a poisonous gas, and pro- 
duces asphyxia. Some physiologists claim that the normal carbon 
dioxid of the air performs an important function in respiration, 
and that it is the permanent stimulant of the respiratory centers. 

Respiration, aside from the changes occurring in the composi- 
tion of the air, may be materially influenced by injuries of the 
muscles of the thorax or diaphragm; by contraction of the larger 
and smaller bronchi and alveoli, which may interfere with the 
ready passage of the air; by interference with the ready flow of 
blood through the capillaries, and thereby preventing close con- 
tact with the oxygen ; by an inability of the blood to absorb oxygen 
— when the blood is already chemically saturated with some other 
gas, as in potassium chlorate poisoning, etc. ; or by an inability of 
the tissue cells to take up oxygen, as in poisoning with cyanids. 
The usual result of these many disturbances is dyspnea — that is, a 
difficult or labored breathing. 

Dyspnea tends to remove the obstructions in various ways. 
Forcible respiration is the usual method employed by nature to 
give relief. The artificial provision of oxygen, including air, 
under slight pressure is usually of marked benefit, and incidentally 
quickly replaces the accumulated carbon dioxid. Drugs which 
are intended to relieve the various causes of disturbances of respira- 
lion depend on the nature of the latter. Antiseptics, astringents, 
and styptics are principally called for in tubercular diseases of the 
lungs. Oil of turpentine and other essential oils of the pine 
family, oleo-resins, creosote, and guaiacol are largely employed in 
phthisis; they are preferably administered in a very fine state of 



338 PHARMACO-THERAPEUTICS. 

division by using an atomizer. Hypersecretion of the mucous 
membranes is checked by mild doses of atropin sulphate, while 
an increased secretion is usually readily obtained by the adminis- 
tration of expectorants. Ipecac, potassium iodid, and ammonium 
chlorid, together with many drugs containing sugar and muci- 
laginous substances — licorice, marshmallow, Irish moss, mullein, 
elder flowers, squills, honey, etc. — are much lauded in liquefying 
the dried-up secretions. The irritation of a cough is best delayed 
by opium or morphin. Irritability of the centers of respiration is 
usually readily reduced by morphin and quebracho. True asthma 
— tonic spasms of the smooth muscle fibers of the bronchial alveoli 
— is relieved by carefully adjusted doses of atropin sulphate, and 
by lobelia, amyl nitrite, and the fumes of saltpeter. The centers 
of respiration may be directly stimulated by hypodermic injec- 
tions of strychnin sulphate. Artificial respiration is of prime 
importance in cases of complete cessation of respiration; it is 
referred to under General Anesthetics. 

Cough Mixture. 

$. Ammonii chlorid. 3 J (4.0 Gm.) 

Tinct. opii camphor. A3 iv (15 Cc.) 

Fluidextract. liquoric. flg j (30 Cc.) 

Aquae ad fl^ iv (120 Cc.) 

M. 
Sig. : Tablespoonful three times a day. 

TONICS. 

Tonics, sometimes referred to as roborants, are medicines 
intended to give strength or "tone" to the system. Tonics, like 
alteratives, do not belong to a definite pharmacologic group ; they 
do not act on specific organs, but on the organism as a whole. 
Tonics are administered for the purpose of increasing the nutrition 
of the whole body by a slight stimulation of all its vital functions, 
and thereby give greater resistance to the organism against external 
deleterious influences. Iron, arsenic, phosphorus, and lime are the 
principal types of true tonics. Iron is known as exercising a spe- 
cific influence on the blood, and consequently it is sometimes 



TONICS. 369 

referred to as a hematinic. Arsenic seems to cause a definite 
unknown stimulation of cell activity in general, and phosphorus 
furnishes most necessary components of the soft tissues as well as 
of the bones. Calcium is the essential component of bone structure, 
and is present in the blood. Recently fluorin has been advocated 
as a specific tonic in dental caries. 



Iron. 

Iron is a normal constituent of the blood; it is present in the 
hemoglobin of the red corpuscles. Hemoglobin is the agent which 
is directly concerned with the interchanges of oxygen and carbon 
dioxid in indirect respiration. The average daily waste of iron 
derived from the red blood corpuscles and other cells amounts 
to about Ve t° Vi grain (0.01 to 0.016 Gm.). This loss of iron is 
more than readily replaced by the organic iron which is contained 
in the ordinary mixed foodstuffs. In certain diseases, however, 
which are principally the result of an altered composition of the 
blood (chlorosis), or of an insufficiency of its quality and quantity 
(anemia), the natural supply of iron is not sufficient, and an 
artificial increase of the iron component is essential. Usually 
within a comparatively short time marked improvement in the 
blood is shown after the iron administration. Just how iron acts in 
the body is not fully known at present, but it is probably certain 
that it causes a direct stimulation of the blood-forming centers — 
the erythroblasts in the marrow of the long bones. 

The iron of the blood and of the foodstuffs is a peculiar organic 
compound, which is not altered by the ordinary iron precipitants. 
The inorganic iron preparations are represented by ferrous and 
ferric salts. When they are taken internally in moderate doses, 
only very small quantities of these salts are absorbed; for the most 
part they are excreted with the feces. Concentrated iron salt solu- 
tions act as caustics on the mucous membrane of the gastro- 
intestinal canal. Chemists have endeavored to produce organic 
iron compounds analogous to those existing in the body. Quite 
a large number of organic compounds, which represent the iron in 
a so-called "masked" (nonionic) form, have been introduced 



370 PHARMACO-THERAPEUTICS. 

within the last decade. The prototype of these compounds is fer- 
ratin, a ferric albumin acid containing 6 percent of iron. Ferratin 
is readily absorbed, and is easily borne by the patient; neverthe- 
less clinicians of wide experience claim that with this or any other 
masked iron no better therapeutic results are obtained than with 
the old-fashioned inorganic compounds or the ferruginous mineral 
waters. 

Manganese is sometimes added to iron to increase its action on 
the blood; its therapeutic value is denied by most clinicians. It 
is usually administered as an organic iron and manganese pepto- 
nate in a weak alcoholic solution flavored with aromatics. 

Iron is usually administered after meals, and the many official 
preparations leave a wide choice for the selection of the proper 
form of the medicament. Quite a large number of iron prepara- 
tions are described in the pharmacopeias, and it is quite unneces- 
sary to enumerate all of these compounds. The preparations espe- 
cially in favor with the clinicians are : 

Mass of ferrous carbonate, massa ferri carbonatis, U. S. P. ; Val- 
let's mass; average dose, 4 grains (0.25 Gm.). Pills of ferric car- 
bonate, pilulte ferri carbonatis, U. S.' P., B. P.; average dose, 2 
pills. Saccharated ferrous carbonate, ferri carbonas saccharatus, 
U. S. P., B. P.; average dose, 4 grains (0.25 Gm.). Various 
wines, syrups, and solutions containing iron salts, and the many 
organic preparations, among which the following are the more 
prominent: Ferratin, carniferin, hematogen, hemol, hemogallol, 
ovoferrin, triferrin,.and the solution of ferro-mangan peptonate. 
The latter solution has been apparently very largely prescribed in 
the last few years. Certain inorganic iron compounds, especially 
solutions cf iron chlorid, iodid, lactate, sulphate, and pyrosulphate, 
readily destroy the enamel and cause a pronounced black discolora- 
tion of the teeth. This is also true, as Morgenstern has shown, in 
regard to many of the ferruginous mineral waters. Most of these 
iron compounds act on the enamel, principally by virtue of their 
acid component; reduced iron, saccharated iron, and masked iron 
do not affect the teeth. When corrosive iron preparations are pre- 
scribed, they should be taken well diluted and through a glass 
tube. 



TONICS. 371 

Iron Tonic. 

J$l Strychnin, sulphat. gr. ss (0.03 Gm.) 

Liquor, ferro-mangan. pepton. flg iv (120 Cc.) 
M. 

Sig. : Dessertspoonful three times daily after meals. 
Caution: Avoid acid fluids. 

Arsenic. 

The action of arsenic on the animal organism manifests itself 
as a typical protoplasm poisoning; it kills the cell by chemically 
disturbing its contents. Administered in therapeutic doses, arsenic 
exercises a definite function on the tissues of the skin, on the blood- 
forming organs, on the osseous tissues, and apparently on the 
lymphatic system. Furthermore, arsenic apparently favorably 
influences certain pathologic disturbances, and it is frequently 
employed in syphillis, in remittent fevers, especially in pernicious 
malaria, in neuralgias, and in other nervous diseases. The thera- 
peutic action of arsenic is not fully understood. It is believed that 
arsenic produces some form of irritation which stimulates the cells 
to greater activity. This supposition is based on observations made 
in regard to its action on the tissues when administered as a poison. 
For a detailed description of the action of arsenic trioxid on the 
pulp see page 203. 

Arsenic is principally administered in the form of Fowler's 
solution, in pill form, and as natural arsenical mineral water. The 
principal spas which are known to be rich in arsenic are those of 
Kudowa (Silesia) and of Levico and Roncegno (Tyrol). Recently 
organic preparations of arsenic in the form of an alkyl com- 
pound, and known as atoxyl arsenate, have been introduced. They 
are intended for internal or hypodermic administration. Arsenic 
preparations are preferably taken after meals. 

Solution of Potassium Arsenite; Liquor Potassii Arsenitis, 
U. S. P. ; Liquor Arsenicalis, B. P. ; Fowler's Solution. 

It is a 1-percent solution of arsenic trioxid neutralized with 
potassium bicarbonate in water, to which compound tincture of 
lavender is added to give it color and flavor. 

Average Dose. — 3 minims (0.2 Cc). 



372 PHARMACO-THERAPEUTICS. 

Arsenical Tonic. 

I£ Liquor, potass, arsenit. A3 iij (12 Cc.) 

Aquae menth. pip. ad fl£ j (30 Cc.) 

M. 

Sig. : 5 drops in water three times daily after meals. The 
dose is increased daily by 1 drop until 15 drops three times 
daily are taken. 

Phosphorus. 

Phosphorus is present in extremely small quantities in the 
albumin of every cell, and as calcium phosphate it furnishes an 
important inorganic component of the bones and teeth. The 
therapeutic administration of phosphorus is restricted principally 
to diseases of the bones — rachitis and osteomalacia. If the true 
tonic action of phosphorus is desired, it should be given in an oily 
solution ; cod liver oil is especially adapted for this purpose. The 
many solutions of hypophosphites, lactophosphates, and, recently, 
of glycerophosphates in syrup, which constitute an important item 
in popular medicine and with many practitioners, are ill adapted 
for this purpose ; they are not absorbed by the tissues, and prac- 
tically all of the administered phosphates leave the body with the 
urine. Through their rich sugar component they frequently 
derange the digestion. 

Phosphorus poisoning has been frequently observed in those 
exposed to its vapors, especially in match factories. The phos- 
phorus vapors pass through a carious tooth or some other channel 
into the body of the jaw, causing a severe periostitis, which is fol- 
lowed by necrosis of the jaw. Microbal infection as a sequence of 
the lessened resistance of the involved tissues is necessary to com- 
plete the clinical picture of true phosphorus necrosis. The sub- 
stitution of amorphous phosphorus for the metalloid and improved 
dental hygienic conditions of the workmen have largely eradicated 
the causative factors of this disease. , 

Phosphorus Tonic. 

J$l Phosphorus gr. iij (0.2 Gm.) 

Olei morrhuae flg xvj (500 Cc.) 

M. 

Sig. : Teaspoonful three times daily an hour after meals. 



tonics. 373 

Fluorin. 

Fluorin in the form of calcium fiuorid has been recently sug- 
gested as a therapeutic means to increase the resistance of tooth 
structure against caries. Fluorin is principally found in the 
enamel, although only in very small quantities. According to 
recent analyses made by Hempel and Jodlbauer the average 
amount of fluorin present in the enamel of human teeth varies 
from 0.26 to 0.35 percent. Some observers claim that the resist- 
ance of the teeth against dental caries depends largely on the 
fluorin component of the enamel. Daninger 1 claims that the 
internal administration of calcium fluorin does no harm, and that 
it increases the firmness of the teeth and the alveoli. The chil- 
dren of women who had taken calcium fluorid daily during their 
pregnancy had, without exception, good teeth. In older children 
calcium fluorid also had a good effect on the formation of the 
teeth. Following Daninger's suggestion, Brissemoret 2 has admin- 
istered calcium fluorid with apparent good results in the medicinal 
treatment of dental caries and in fractures. As yet no positive 
proof has been furnished for this supposition ; but, as calcium 
fluorid in therapeutic doses is a harmless remedy, it seems reason- 
able to try it in suitable cases. 

Calcium. 

Lime salts are important constituents of the animal tissues, and 
form the most important inorganic component of bones and teeth. 
They are also found in the soft tissues, and apparently exercise 
important functions on certain ferments — fibrinogen of the blood, 
etc. The lime salts are rather insoluble, and when they are admin- 
istered internally they usually leave the body unaltered. In lime 
starvation in children — a deficiency of lime in the food — 
undoubtedly an insufficient amount of lime is deposited in the 
bones and the teeth. The results are the well-known ill-formed 
bones in rickets and weak teeth ; the latter show a pronounced ten- 
dency to caries. In a very interesting monograph Rose 3 has 



1 Daninger: Deutsche Zahnarztliche Wochenschrif t, 1907, p. 196. 

2 Brissemoret: Revue Internationale de Medecine, 1908, p. 351. 

3 Rose: Eixhalzarmut und Entartung, 1906. 



374 PHARMACO-THERAPEUTICS. 

recently shown that a deficiency of lime salts must be, to a large 
extent, held responsible for the so-called soft teeth which are so 
frequently met in persons living in regions in which the natural 
lime supply of the drinking water is below the normal. 

The normal individual ingests with his daily mixed diet in one 
year approximately a pound of calcium oxid and about seven 
pounds of phosphoric acid. The very largest part of these sub- 
stances is utilized by the body for the maintenance of the body 
frame. An average human skeleton weighs about 24 pounds, and 
is composed, according to Heintz, of 9.26 pounds of lime and 12.9 
pounds of phosphoric acid. According to the above calculation, 
the mixed diet furnishes in two years more than the necessary 
quantity of phosphoric acid, while about ten years will be required 
to bring up the amount of lime salts to the standard. It seems but 
rational, therefore, to select such foodstuffs, especially for infants 
and children, as contain a large percentage of organic calcium 
salts. 

As to furnishing the body with inorganic substances in the 
form of calcium, magnesium, fluorin, and phosphorus compounds, 
which are needed in building up the osseous tissues, it is question- 
able if these insoluble compounds are of benefit. As far as lime 
salts and phosphorus compounds are concerned, it is known that 
for the most part they are again excreted. If there is a real need 
for these substances, a rational therapy points to the utilization of 
compounds which furnish these materials in organic combinations 
and which are products of nature. Coarse wheat and rye flour are 
rich in phosphoric acid, while lime salts (inorganic lime) are 
usually found in hard drinking water and in most vegetables, espe- 
cially beans, cauliflower, rutabaga, and cabbage. The addition of 
small quantities of lime water to milk or drinking water appar- 
ently has a beneficial influence on bone formation. En passant it 
may be mentioned that the stories which still circulate among the 
laity, and to some extent even among practitioners, regarding the 
removal of lime salts from the teeth of the mother during preg- 
nancy to build up those of her offspring, are wholly unfounded. 
A well-regulated diet, rich in lime and phosphates, and sufficiently 
coarse to call forth vigorous use of the jaws, and regular exercise 



ALTERATIVES. 375 

in the open air, is the foundation of a strong skeleton and sound 
teeth. 

Internal Treatment of Dental Caries. 

Ifc Calcii fluorid. gr. j (0.06 Gm.) 

Magnes. phosphat. 
Calcii phosphat. 
Calcii carbonat. aa 5 j (4.0 Gm.) 

M. f. pulv. No. xx 

Sig. : A powder twice a day during meals. 



ALTERATIVES. 

Alteratives (to change) are drugs which so favorably modify 
nutrition as to overcome morbid processes ; they promote metabol- 
ism. Modern pharmacologists have discarded the term alteratives 
because the drugs belonging to this group do not act on specific 
organs, but on the organism as a whole. The drugs which are 
usually referred to as alteratives do not produce distinct symptoms 
when taken in ordinary doses ; apparently no direct stimulation or 
depression can be observed, but nevertheless their therapeutic 
influence on the system as a whole is an assured clinical fact. 

The simplest remedy which causes changes in the metabolism 
of the tissues is water. Water, when systematically ingested, 
cleanses the mucous linings of oral cavity and stomach, and 
thereby increases their activity. Its passage through the body 
hastens the breaking down and the removal of protoplasm, which 
appears in increased quantities, as nitrogenous compounds in the 
urine. Mild saline solutions — sodium chlorid, with minute addi- 
tions of sodium bicarbonate and impregnated with carbonic acid 
gas — are of still greater benefit to the organism. Their influence 
on the mucous linings of the stomach manifests itself in an 
increased appetite, and, as in the drinking of plain water, the 
quantity of urine and its solid constituents are increased. Ingest- 
ing potassium salts increases the excretion of sodium salts from 
the body; the latter must be replenished to restore the normal 
equilibrium of the tissue fluids. Certain other salts, especially 
iodin and mercury compounds, exercise, aside from their general 
action, a specific influence on the whole system. 



376 PHARMACO-THERAPEUTICS. 

The iodids form the most important group of those drugs which 
generically are termed true alteratives. Potassium iodid is the 
most favored representative of this group. Of the other iodin 
preparations, sodium iodid and syrup of hydriotic acid are the 
most universally emplo3 r ed compounds. Almost equally as impor- 
tant as the iodin compounds are the mercury preparations. Again, 
only the readily soluble salts of mercury are employed as altera- 
tives, especially the bichlorid and the biniodid of mercury. When 
mercury passes through the body of the cell it forms a union 
with the albumin of its protoplasm and produces irritation, which, 
depending on the quantity of the absorbed mercury, is more or 
less pronounced. If the absorbed quantity is too large, the cell 
dies from the caustic action of the poisoning. (See page 84.) 
Of the vegetable drugs, sassafras, guaiac, sarsaparilla, etc., have an 
old reputation as being highly valued alteratives; the latter has 
been much lauded as being especially efficacious, and is still widely 
used in the treatment of syphillis. This belief is wholly 
unfounded ; the empiric use of sarsaparilla in the form of a syrup, 
decoct, etc., as a vehicle for potassium iodid or mercury bichlorid 
has no influence on the disease. The alkalies and, to some extent, 
the acids, when ingested into the system, are of importance in so 
far as they furnish chemicals which are needed for the main- 
tenance of the proper composition of the body juices. The alkalies 
are especially called for to rehabilitate, under certain conditions, 
the alkalinity of the blood — in coma of diabetes, where large quan- 
tities of acid are stored in the organism. Only mild alkalies, espe- 
cially the sodium bicarbonate, are useful for internal administra- 
tion; potassium bicarbonate, lithium carbonate, and a few others 
are also used. The acids were much more freely employed in 
former years, with the belief that they could influence nutrition. 
The fruit acids act only as relishes. 

Iodids. 

Iodin, in its pure state, is not used internally, but sometimes it is 
administered in the form of an alcoholic solution, well diluted 
with water, or as an oily solution. Its pharmacologic action is 



ALTERATIVES. 377 

most pronounced when it is ingested in the form of its soluble 
salts, especially as potassium or sodium iodid. Potassium iodid is 
.decomposed in the body in the presence of sodium chlorid into 
potassium chlorid and sodium iodid; both salts are removed from 
the tissues by the urine and through all the glands. The iodin ion 
stimulates the cells to a higher activity, and incidentally promotes 
absorption. The latter fact is important in the treatment of 
chronic metallic poisoning — lead and bismuth line in the mouth, 
argyria, etc. Pathologic tissues are markedly influenced by iodids ; 
they apparently cause a forcible breaking down of necrotic and 
necrobiotic structure ; hence their value in the treatment of tertiary 
stages of syphilis. The resistance of the vessel walls is lessened by 
the iodin salts, and this fact may help to explain their beneficial 
action in arterio-sclerosis. Iodids are often given with expec- 
torants to render the bronchial secretions more soluble. Pro- 
longed administration of an iodid is prone to cause iodism, which 
manifests itself in salivation, frontal headache, and cough. 
Iodids have a disagreeable, bitter taste ; they are best administered 
in milk. The various organic compounds of iodin and their solu- 
tions are referred to under Halogens, and Irritants and Counter- 
irritants. 

Potassium Iodid; Potassii Iodidtjm, U. S. P., B. P. ; KI; Iodure 
de Potassium, F. ; Jodkali, G. 

It forms transparent, colorless, or opaque white crystals, or a 
white granular powder, having a peculiar, faint, iodin-like odor 
and a pungent, saline, bitter taste It is soluble in 0.7 parts of 
water, about 12 parts of alcohol, and about 2.5 parts of glycerin. 
It is incompatible with calomel, chloral hydrate, acids, and alka- 
loidal and metallic salts. 

Average Dose. — 7 1 / 2 grains (0.5 Gm.). 

Sodium Iodid; Sodii Iodidum, U. S. P., B. P.; Nal; Iodure de 
Sonde, F. ; Jodnatron, G. It forms colorless, cubical crystals, or a 
white, granular powder, having a saline, bitter taste. It is soluble 
in about 0.5 part of water and 3 parts of alcohol. Average dose, 
7 1 / 2 grains (0.5 Gm.). 

Ointment of Potassium Iodid; Unguentum Potassii lodidi, 



878 PHARMACO-THERAPEUTICS. 

U. S. P., B. P. It is an ointment containing 10 percent of potas- 
sium iodid. 

Concentrated Potassium Iodid Solution 

fy Potassii iodid. % j (30.0 Gm.) 

Aquae destill. ad fl§ j (30 Cc.) 

M. 
Sig. : 5 drops three times daily in a glass of milk. 



Mercury Salts. 

Mercury possesses a great affinity for albumin, with which it 
very quickly enters into a chemic union. The readily soluble 
mercury compounds naturally act the quickest, while mercury, in 
its metallic state or in an insoluble form, passes unaltered through 
the body ; hence the assertion that red dental rubbers, which are 
often colored with natural cinnabar or with artificial red mercuric 
sulphid (vermilion), cause mercurial stomatitis is wholly un- 
founded, and the same is true of the mercury component of 
amalgam fillings. Mercurials are comparatively easily absorbed 
by the mucous linings of the intestinal tract, and they may then 
cause chronic intoxications. Acute poisoning with mercurials is 
never observed, but it may be artificially induced. The absorbed 
mercury is excreted by the kidneys, the intestines, the mucous 
surfaces, and the various glands. Intense salivation is often 
noticed as a result of mercury absorption ; it is apparently due to a 
direct stimulation of the secretory centers. The saliva contains 
mercury and has a pronounced metallic taste. The irritation 
caused by the mercury produces excoriation of the mucous linings 
of the mouth, starting usually about the posterior teeth. Teeth 
with ragged edges and those covered with calcareous deposits invite 
irritation. The denudation in the presence of pathogenic bacteria 
soon leads to ulceration, which is accompanied by an intensely foul 
odor. The destruction of the soft tissues may involve large parts 
of the gums, the palate, etc., followed by periostitis, but rarely by 
necrosis of the bone. A thorough hygienic care of the oral cavity 
before and during a course of mercurial treatment invariably pre- 
cludes the formation of mercurial stomatitis. The compound solu- 



ALTERATIVES 379 

tion of hydrogen dioxid (see page 113) deserves to be specially 
recommended as an oral antiseptic under these conditions. 

Mercury is the remedy par excellence in syphilis ; here it acts as 
a true specific. Whether mercurials act as a direct poison to the 
recently discovered causative factor of syphilis, the spirochaete 
pallida, is as yet not fully known. A carefully inaugurated mer- 
cury treatment will never do harm. It will keep the exciting- 
organisms in check, and prevent the secondary stage of syphilis if 
ingested early enough. The constitutional treatment of syphilis 
belongs to the domain of the medical practitioner. The admin- 
istration of mercury depends on its various salts, on the metal in 
a fine state of division (mercurial ointment or colloidal mercury), 
and on recently introduced organic compounds. These remedies 
may be introduced by internal administration, by injection, or by 
inunction. The various salts of mercury have been discussed 
under Salts of the Heavy Metals. 

For Mercurial Stomatitis. 

& Vioformi 5 ss (2.0 Gm.) 

Glycerini flg j (30 Cc.) 

M. 

Sig. : Paint on the ulcerated surfaces and cover with strips 
of lint. 

Within the last few years a remedy has been introduced in 
therapeutics Avhich is said to possess a selective power on pathologic 
fibrous tissues, causing its absorption and facilitating the stretch- 
ing of the cicatrix. It is known as fibrolysin, and, as no other 
pharmacologic group will allow its admittance, we prefer to discuss 
it at this point. 

Fibrolysin is an aqueous solution of thiosinamin and sodium 
salicylate, marketed in sterilized sealed tubes, each containing 35 
minims (2.3 Cc), which is equivalent to 3 grains (0.2 Gm.) of 
thiosinamin. The solution is preferably introduced by intramus- 
cular injections as closely as possible to the seat of the cicatrix, but 
not into it. Special care is necessary not to inject too close to the 
surface, as it may cause sloughing. The injection is made under 
strict aseptic conditions, and should be repeated every second or 



380 PHARMACO-THERAPEUTICS. 

third day. It is difficult to state how many injections are neces- 
sary, as that will depend largely on the size of the cicatrix. 
Usually from eight to ten injections are required, and, again, as 
many as twenty-five injections have been necessary in large scars. 
There are scarcely any unpleasant after-effects to be recorded; 
slight rise of temperature and a few cases of nausea and vomiting 
have been noticed. The exact mechanism by which fibrolysin 
acts is unknown ; it has been stated that a hyperemic congestion is 
established, which may explain the cause of the softening of the 
fibrous tissues. 

The injection of fibrolysin in dental surgery is indicated in 
scars caused by an alveolar abscess discharging upon the face. 
These scars are usually very disfiguring, and fibrolysin deserves to 
be tried in such cases, especially where there is an opportunity to 
use it soon after their formation. 

SIALOGOGUES AND ANTISIALOGOGUES. 

Drugs which increase the flow of saliva are known as sialogogues 
or as ptijalogogucs (to cause the flow of saliva), and those which 
diminish it are known as aniisialogogues. Saliva is a secretion 
which is utilized by the body as an important adjunct in prepar- 
ing the food bolus for digestion. The mixed saliva is derived from 
the parotid, submaxillary, and sublingual glands; the other oral 
glands furnish verj^ small quantities of alkaline secretion. Few 
oral glands are found on the gums and on the hard palate. Mixed 
saliva is usually slightly acid after midnight, and toward morning 
it is often found to be slightly acid or amphoteric. After meals it 
is mostly distinctly alkaline for one or more hours. In certain 
pathologic conditions — diabetes mellitus — Lehmann claims to 
have obtained positive reaction for free lactic acid, while Frerichs 
and Von Norden speak of the presence of free oxibutyric acid and 
diacetic acid, and sometimes of the progenitor thereof, aceton, in 
the same disease. In man y febrile diseases — typhoid, appendicitis, 
cholera infantum, etc. — and in disturbances of metabolism a tem- 
porary acidity of the saliva is observed. The mixed saliva also con- 
tains mucin, a glucosid, which is insoluble in water. In the pres- 



SIALOGOGUES AND ANTISIALOGOGUES. 381 

ence of alkalies it forms a colloidal solution, while acids precipitate 
it. The so-called ropy saliva — saliva containing precipitated 
mucin — is frequently an indicator of an existing hyperacidity of 
the mouth. Mucin has been held responsible by some investi- 
gators (Lohmann) as a factor in causing dental caries. This 
statement has been emphatically denied by Miller. Saliva also 
contains the important enzyme ptyalin (diastase), a product pres- 
ent in the parotid glands. Oral digestion, the change of starch 
into sugar, which takes place only in alkaline reaction, depends on 
the presence of ptyalin. Ptyalin is not present in carnivorous 
animals and in milk-fed infants. Normally, as well as in general 
pathologic disturbances, variable quantities of ammonia, urobilin, 
biliary pigments, cholesterin, lecithin, etc., may also be found in 
the mixed saliva. ^ 

Sialogogues. 

Sialogogues are indicated in an abnormal dryness of the mouth. 
Diminished secretion of saliva results from the injections of cer- 
tain drugs — belladonna (atropin), henbane, scopola, stramonium, 
etc. — or from so-called ptomain poisoning, which may result from 
eating decaying meat, cheese, fish, etc. Many febrile diseases also 
diminish the flow of saliva, or cause a drying up of the normal- 
moisture of the oral mucous linings. Dry mouth (xerostomia) 
results from an impaired secretion of saliva, which may be caused 
by severe physical or psychic disturbances of the nervous system, 
diseases of the digestive tract, and other unknown factors. 
Atrophy of the salivary glands may destroy their functions com- 
pletely. To prevent dryness of the air in the sick room, which is 
very likely to occur in the modern furnace-heated houses, pans 
filled with fresh water should be placed about the room. Small 
quantities of fresh drinking water, or acidulated with' organic 
acids (lemon juice, tartaric acid) , should be given at frequent 
intervals to the patient. Spices and the simple bitters — gentian, 
quassia, columbo, dandelion, etc. — as well as the chewing of semi- 
solid, insoluble material — gum, rubber, etc. — increase the flow of 
saliva. Tobacco, the iodin compounds, certain mercury prepara- 
tions, and vomiting also cause a profuse flow of saliva. 



382 PHARMACO-THERAPEUTICS. 

The supreme sialogogue is pilocarpus (jaborandi). It is best 
prescribed as the hydrochlorid of the alkaloid, pilocarpin. Pilo- 
carpi acts on the terminations of the secretory nerves, especially 
the minute fibrils which ramify between the epithelial cells. It 
is principally indicated in the treatment of dry mouth (xeros- 
tomia). If this disease results from nervous disturbances, elec- 
tricity is of some value. While recovery from true xerostomia is 
very problematic, the patient may be made comfortable by the use 
of pilocarpin. 

Pilocarpin Hydrochlorid ; Pilocarpine Hydrochloridum, 

U. S. P. ; CuH^NAHCi. 

It is the hydrochlorid of an alkaloid obtained from jaborandi 
leaves. It appears in smUl white crystals, odorless, with a slightly 
bitter taste. It is very soluble in water and alcohol. 

Average Dose. — y 5 grain (0.01 Gm.). 

PiLOCARriN Nitrate; Pilocarpine Nitras, U. S. P. B. P. • 

C 11 H 1C N 2 2 HN0 3 . 

It is the nitrate of an alkaloid obtained from jaborandi leaves. 
It forms a white crystalline powder, which is soluble in about 10 
parts of cold water and freely soluble in hot alcohol. 

Average Dose. — y o grain (0.01 Gm.). 

For Dry Mouth. 

fy Pilocarpin. hydrochlorid. gr. v (0.3 Gm.) 

Aquae destillat. flg ss (15 Cc.) 

M. 

Sig. : 5 drops three times daily. Slowly increase the dose 
by 1 drop until from 8 to 10 drops per dose are taken. 

Antisialogogues. 

Ptyalism often results from a general poisoning with mercury, 
bismuth, iodin, and bromin preparations, pilocarpin, aconitin, 
physostigmin, etc. These poisons may have been administered by 
the mouth, hypodermically, or they may have been absorbed from 
wound surfaces. The supreme remedy to stop the flow of saliva is 



DIAPHORETICS. 383 

atropin ; it paralyzes the chorda tympani and the sympathetic 
nerve endings in the salivary glands. Small doses of atropin are 
often given advantageously to a patient afflicted with an abnormal 
flow of saliva prior to dental operations in which the rubber dam 
can not be applied. 

Atropin Sulphate; Atropine Sulphas, U. S. P., B. P.; 

(C 17 H 23 N0 3 ) 2 .H 2 SO,. 

A white crystalline powder, prepared from the alkaloid atropin 
derived from belladonna leaves. It has a very bitter taste, and is 
freely soluble in water and alcohol. 

Average Dose. — 1 / lft0 grain (0.0004 Gm.). 

I£ Pil. atropin. sulphatis gr. Hgo (0.004 Gm.) 

No. ij 

Sig. : One pill in the evening and one in the morning before 
the dental operation. 

DIAPHORETICS. 

Diaphoretics (to carry through), sometimes called sudorifics 
(to sweat), are remedies employed for the purpose of increasing 
perspiration. Normal perspiration is constantly produced by the 
sweat glands, while the so-called insensible perspiration results 
from the evaporation of water which is derived from superficial 
capillaries and lymph channels. Perspiration is spontaneously 
increased in heated surroundings and during muscular exertion. 
The control of perspiration is principally due to specific nerves, 
although direct irritation of the sweat glands may also produce 
perspiration. The true diaphoretics excite the sweat centers as well 
as the peripheral endings of the sweat nerves, while the indirect 
diaphoretics create only an active hyperemia of the skin. Psychic 
influence — fear, excitement, etc. — may also produce perspiration 
by reflex action. The sweat is principally composed of water 
(97y 2 to99y 2 percent), the solid constituents being cholesterin, 
aromatic fatty acids, aromatic oxy-acids, ethyl sulphuric acid, 
urea, and various salts, especially sodium chlorid and alkaline sul- 
phates and phosphates. The normal fresh perspiration of man 
reacts acid, but the stagnated sweat is usually alkaline. Pure meat 



384 PHARMACO-THERAPEUTICS. 

diet produces an acid sweat, while vegetable diet always furnishes 
alkaline perspiration. In infectious diseases the sweat may elim- 
inate waste products of microbal origin, in diabetes it may contain 
sugar, and in uric acid diatesis it may contain uric acid salts. 
Internally administered drugs — salicylic and benzoic acid and 
their salts, iodin, bromin, mercury, lead, quinin, essential oils, etc. 
— may also be excreted by the sweat. Apparently the production 
of sweat diminishes with the age of the individual. 

Sweating as a therapeutic procedure is rarely practiced at pres- 
ent, except in certain chronic diseases and in those' conditions 
which are generically termed "colds." The simplest means of 
bringing about profuse perspiration is by the ingestion of hot fluids 
and a diminishing of heat radiation by wrapping the patient in 
heavy covers. Mild alcoholic liquids in the form of hot toddies, 
hot coffee or tea are especially productive of free perspiration. 
Pilocarpin is the most effective of all diaphoretics; it may be 
administered as the hydrochlorid salt of the alkaloid pilocarpin, or 
in the form of an infusion of the jaborandi leaves. Elder flowers 
and linden flowers are still largely used by the laity for this pur- 
pose. Dover's powder in small doses, alone or combined with the 
salicylates (asperin), or the spirit mindererus (solution of am- 
monium acetate, U. S. P., B. P.), are frequently employed by the 
clinician for the production of mild perspiration. Turkish, elec- 
tric light, hot air, and sun baths as means of producing profuse 
perspiration have gained much favor in recent years. 

Pilocarpin and its salts have been referred to under Sialogogues 
and Antisialogogues. 

DIURETICS. 

Diuretics (to increase the secretion of urine) are remedies 
employed for the purpose of promoting the secretion of urine. 
The organ which secretes the urine is the kidney. Under normal 
conditions the kidney performs three functions — it maintains the 
osmotic equilibrium of the blood, it removes the end products of 
metabolism of the protoplasm, and it eliminates foreign substances 
from the system. Urine is secreted by the combined activity of the 



DIURETICS. 385 

glomeruli and the convoluted tubes; the former secrete a fluid — 
poor in salts, but rich in water, while the latter reverse the 
process — rich in salts and poor in water. The urine may be acid, 
alkaline, or neutral in reaction. (See Urine Analysis.) Oc- 
casionally it is desirable to produce an increased flow of urine 
which should react either acid, alkaline, or neutral. From a 
physiologic point of view it is also of interest to know that with the 
urine certain drugs are excreted which were administered for 
specific purposes. 

Diuretics are administered for the purpose of removing path- 
ologic collections of exudates which may have been confined in 
body cavities or between the tissues, as in diseases of the heart, 
nephritis, cirrhosis, etc. They are also given to remove poisons 
which have entered the body or which are formed in the body, and 
to mechanically flush the uriniferous tubules, which may be 
clogged by foreign materials. Flushing of the entire urinary tract 
includes the kidney, ureter, and bladder, and it is often employed 
for the purpose of preventing the formation of concrements in 
these tissues. 

The many drugs which possess a more or less pronounced 
diuretic action are closely related to diaphoretics and uric acid 
solvents. Water is an important diuretic, and we have referred 
to it more particularly under Alteratives and Uric Acid Solvents. 
An indirect irritation of the epithelial coat of the kidneys, which 
produces increased activity, is caused by many essential oils — oil 
of turpentine, juniper, parsley — and many roots and herbs which 
contain irritating substances. Many salines, especially potassium 
and sodium acetate, sodium nitrite, lithium carbonate, etc., are 
lauded as diuretics; the solutions of ammonium acetate, U. S. P., 
B. P., and the spirit of nitrous ether, U. S. P., B. P., enjoy a wide 
reputation. Of the heavy metals, calomel in large doses is produc- 
tive of an increased quantity of urine. A direct stimulation of the 
epithelium of the kidneys is readily obtained by caffein and theo- 
bromin ; they do not irritate the kidneys, and may be given in 
comparatively large doses. Theobromin is principally adminis- 
tered in combination with sodium salicylate, known as diuretin. 
Caffein has been referred to under Cerebral Stimulants. 



386 PHARMACO-THERAPEUTICS. 

Theobromin Sodium Salicylate; Theobromine Sodio-Sali- 
cylas ; NaC 7 H 7 N 4 2 +NaC 7 H 5 3 ; Diuretin. 

It is a white powder, ockMess, and having a saline taste. It is 
freely soluble in water, but is decomposed in the presence of 
carbon dioxid. It should be given in well-diluted solutions. 

Average Dose. — 15 grains (1 Gm.). 

URIC ACID SOLVENTS. 

Uric acid solvents, also referred to as lithontriptics or antilithics 
(stone destroyers), and as antiarthritics (gout remedies), are 
drugs employed for the purpose of dissolving uric acid and increas- 
ing its excretion. 

Uric acid as a causative factor of dental disease has been for a 
decade or more a prolific theme of discussion. Like all subjects 
pertaining to medicine, as well as many other matters which are 
clothed in mystery, it gives rise to much unsound speculation. 
Regarding the process of uric acid formation, excretion, destruc- 
tion, retention, deposition, and solution in health and disease, very 
few absolute facts are known, and consequently the therapeutic 
measures, as far as remedies are concerned, are very limited. There 
is probably no other field in therapeutics about which so little 
"truth" is known and about which so much "poetry" is written 
as the uric acid problem. 1 Apparently, however, this is not true 
in the mind of the nostrum maker. To him the bugbear of uric 
acid diathesis has been and still is the very shibboleth of uncounted 
possibilities. It is not within our present consideration to enter 
into a detailed discussion of the formation of uric acid in the body. 
Let it suffice to say that uric acid is probably formed* in the body 
in various ways — as a product of oxidation from the nucleins of 
the tissue cells and from the xanthin bases of ingested foodstuffs. 
The acid is excreted in the form of purin bodies — uric acid united 
with xanthin bases. Uric acid diathesis is, in all probability, due 
to increased presence or to decreased excretion of formed uric acid. 
The first possibility may result from an increased formation, a 



1 Barker: Truth and Poetry Concerning Uric Acid, 1905. 



URIC ACID SOLVENTS. 387 

decreased destruction, or the solution and removal of gouty 
deposits (tophi). The formation of tophi may result from a dis- 
turbed function of the excretory organs, which produces an 
increased deposition of sodium monourate in the tissues, or from 
a retention of uric acid in the blood and the other tissues. 

In the treatment of dental diseases resulting from uric acid 
diathesis, local and general factors are to be considered. An 
increased presence of uric acid can be positively determined only 
by an analysis of the urine, and it should always be made in every 
case where the general conditions point to its presence. (See 
Urine Analysis.) Entirely too much guess work is done in this 
matter by the average practitioner. The local treatment consists 
in the thorough removal of the deposits about the teeth 1 and the 
restoration of hygienic conditions of the oral cavity. Internal 
medication is directed toward the lessening of the formation of uric 
acid and to an increased excretion. The formation of exagenous 
uric acid is readily controlled by a suitable diet. All foods rich in 
nucleins and purin derivatives are to be avoided — sweetbreads, 
liver, kidneys, etc. ; in fact, all meats or meat soups should be par- 
taken of sparingly. Vegetable proteins, which are found in abun- 
dance in peas and beans, and which are direct forestages of uric 
acid formation, should also be restricted in their use as foodstuffs. 
Whether the formation of uric acid in the body can be inhibited 
at all is as yet not proved. Alcoholic liquors, especially beer, 
exercise a known harmful influence on gouty predisposition. It 
is claimed that quinic (china) acid possesses inhibitory action on 
the formation of uric acid, and as a consequence quite a number 
of compounds containing this acid are found on the market — 
urosin, sidonal, lycetol, lysidin, etc. Their therapeutic value is 
problematic. An increase of the destruction of uric acid in the 
body has also been attempted at various times. So far no positive 
knowledge exists to justify such procedures, although many drugs 
are recommended for this purpose. Again, an increased excretion 
of uric acid is favored by many as a valuable therapeutic aid, and 
here at least positive results can be obtained by materially increas- 



1 Endelman: The Uric Acid Problem as Related to Pericemental Inflammation, Dental Cosmos, 
1908, p. 1076. 



388 PHARMACO-THERAPEUTICS. 

ing the amount of urine excretion. The simplest means for such 
purpose is the copious drinking of water. Ordinary table water 
or mild alkaline mineral waters will answer equally as well. The 
amount of water taken within twenty-four hours should be in- 
creased to about one gallon, which equals approximately sixteen 
tumblerfuls. The salicylates, especially lithium salicylate, have 
been highly recommended — without proof, however — as a solvent 
or as a means of increasing uric acid excretions. It is claimed 
that many of the alkaline metallic salts, especially the salts of 
lithium, possess a definite solvent power on uric acid. While such 
claims have never been substantiated, and are emphatically denied 
by many investigators, lithia is nevertheless widely used at present. 
The administration of lithium compounds is of value as suggestive 
therapeutics. A patient may forget, or even object, to carry out 
the instruction in regard to the drinking of large quantities of 
water which, in his estimation, may be of little consequence, while, 
on the other hand, a prescription calling for lithium citrate tablets, 
with the proper directions, may readily overcome this difficulty. 
Rendering uric acid, when present in the blood, more soluble may 
probably be accomplished by ingesting certain organic substances 
which readily combine with the acid to form nonsalt-like com- 
pounds. Of the various preparations which are suggested for such 
purposes, formaldehyd deserves special mentioning. Formalde- 
hyd in the form of hexamethylen, or compounds of a similar 
nature, furnishes free formaldehyd in the body. It appears in 
the urine as an easily soluble compound of uric acid, the diformal- 
dehyd-uric acid. The combination of these preparations with 
colchicum is often of some advantage ; the clinical results obtained 
justify their empiric administration. 

The rational treatment of uric acid diathesis consists in a well- 
regulated diet, together with proper general hygienic measures. 
The diet should be simple and rather spare ; overloading the system 
must be carefully avoided. According to the observations of Min- 
kowski, 1 the average daily food should consist of about 4 ounces 
(120 grams) of proteins, 2 to 3 ounces (60 to 90 grams) of fat, 
and 8 to 10 ounces (240 to 300 grams) of carbohydrates. Accord- 



1 Minkowski: In Bunge's Physiologic Chemistry, 1902, 



URIC ACID SOLVENTS. 389 

ing to Haig 1 an average day's food may consist of 16 to 20 ounces 
(480 to 600 grams) of breadstuff s, 8 ounces (240 grams) of dried 
fruit, and 8 ounces (240 grams) of fresh fruit; each meal consist- 
ing of 5 to 7 ounces (150 to 210 grams) of breadstuffs, with 2 to 
3 ounces (60 to 90 grams) of dried fruit, and a similar quantity 
of fresh fruit. A little potato may often be substituted with advan- 
tage for fruit at breakfast ; some do well with a little potato at each 
meal and less fresh fruit. Nuts may be added or taken in place 
of some of the breadstuffs by those who like and can digest them. 
Animal food should be used very moderately. 

From the following dietary a suitable uric acid free diet may be 
readily selected: 

Dietary. 

ALLOWED. PROHIBITED. 

Water, especially mild alkaline min- I All raw meats (beef, mutton, and 



eral water. 
Very weak tea. 

White meat of chicken, turkey, quail. 
Meat soups in small quantities only. 
All cereals, rice, and breakfast 

foods. 
All green vegetables. 
Cabbage in moderation. 
Dried fruits and nuts. 
All breads. 
Eggs in moderation. 
Milk. 



pork) . 
All glandular tissues (kidneys, liver. 

and sweetbreads). 
Asparagus, celery, radishes. 
Beans and peas. 
Coffee. 

All liquors, wines, and spirits. 
Pastry and confections. 
Sharp sauces and mayonnaise. 
Mushrooms. 



Frequent bathing, gentle massage, and a few hours' daily exer- 
cise will be of marked benefit. If a month's vacation can be 
taken, with much outdoor exercise and living the simple life, with 
a well-controlled appetite, it will prove highly beneficial. 

The dental disturbances of uric acid diathesis manifest them- 
selves principally in pericemental inflammation, resulting in a 
specific type of systemic pyorrhea alveolaris. The latfer term is un- 
fortunately still frequently, but wrongly, interpreted as signifying 
a pathologic entity. Pyorrhea alveolaris is a collective term 
employed to designate a local manifestation of disease brought 



1 Haig: Uric Acid as a Factor in the Causation of Disease, 1904. 



390 PHARMACO-THERAPEUTICS. 

about by many causes. According to Miller, it may be defined 
as a chronic destructive inflammation of the pericementum, with 
more or less necrosis of the alveolar process of the affected tooth. 
The constitutional causes of pyorrhea may be manifold; diabetes, 
syphilis, B right's disease, gout, etc., are among the more promi- 
nent factors of its production. Gouty pericementitis, a name 
given by Pierce 1 to a form of pyorrhea produced by uric acid 
arthritis, has received much attention in recent literature. The 
formation of uratic deposits in the system, the tophi, is usually 
developed in the skin or in the fibro-cartilage, and consists prin- 
cipally of sodium monourate. On the roots of the teeth — in the 
pericementum — they select principally the upper half of the root 
for their deposition. According to Endelman 2 the deposited urates 
establish a point of minor resistance in the peridental membrane, 
and thus predispose it to the invasion of pyogenic bacteria. The 
nature of the invading micro-organisms determines the character 
of the inflammatory process. In regard to the systemic treatment 
of the gouty form of pyorrhea, it is essential to conform to the 
general rules of the treatment of uric acid diathesis. Talbot 3 rec- 
ommends the following combination in the form of an effervescent 
salt as being especially efficacious in the treatment of dental trou- 
bles arising from a high urinary acidity and from intestinal auto- 
intoxication. Each teaspoon ful of this salt contains: 

Sodium bicarbonate 40 grains (2.6 Gm.). 

Sodium sulphate 10 grains (0.65 Gm.). 

Sodium phenolsulphonate 5 grains (0.32 Gm.). 

Colchicin Y250 grain (0.00023 Gm.). 

Juglandin Vs grain (0.022 Gm.). 

Xanthoxylin Ys grain (0.022 Gm.). 

Aromatics q. s. 

To relieve acute pain, the salicylates, especially asperin, together 
with hot fomentations, are beneficial. If pericemental abscesses 
are present, an early incision, proper drainage, and antiseptic care 
is of importance in the quick relief of the local symptoms. 4 The 

1 Pierce: Pyorrhea Alveolaris, in Kirk's " American Text Book of Operative Dentistry,' 1905. 

2 Endelman: Loc. cit, 

3 Talbot: Interstitial Gingivitis, 1899. 

4 Endelman: Uratic Deposits Upon the Roots of Teeth, Dental Cosmos, 1905. 



URIC ACID SOLVENTS. 391 

thorough removal of the deposits from the teeth and their proper 
splinting is essential to the local treatment of this ailment. To 
facilitate the ready disintegration of calcareous deposits on the 
roots of teeth, Head 1 has recently introduced a solution of 
ammonium bifluorid which is commercially known as tartar sol- 
vent. Head has given the following directions for using this solu- 
tion: 

For the treatment of pyorrhea scrape the roots with scalers as 
thoroughly as possible, and wash out the pockets with warm water. 
Protect the cheek and lips with a napkin ; then, after drying the 
pockets, fill them with the solvent injected by means of a plati- 
num pointed syringe, wiping off all excess from the gums. Change 
the napkins to avoid the possibility of any of the solvent creeping 
up on the cheek through capillary attraction. At the end of two 




Figure 50. 
Dunn Bifluorid Syringe. 

minutes rinse the mouth with water. Apply the solvents twice a 
week— not oftener. During the second or third treatment explore 
the pocket for softened tartar scales which may not have been 
entirely dissolved. When the pockets begin to heal by granulation, 
take care not to allow instrumentation to break down the adhesions. 

When teeth are loose, without tartar, the repeated application 
of the solvent twice a week causes them to become useful for masti- 
cation. Fistulas may be injected full of the solvent, and the mouth 
rinsed at once. The tartar solvent should always be injected and 
never inserted on cotton. If allowed to dry on the mucous mem- 
brane, it will burn like phenol. Ordinary care in wiping off any 
excess will render this impossible. 

It should be remembered that this tartar solvent, on account of 
its hydrofluoric acid component, destroys glass, and consequently 



1 Head: Items of Interest, 1909, p. 174. 



392 PHARMACO-THERAPEUTICS. 

a glass syringe is ill suited for its application. A special small 
syringe, the Dun bifluorid syringe, has been put on the market to 
overcome these defects. 

It is made entirely of rubber, or it may be had with a transpar- 
ent celluloid barrel ; the advantages of the latter are obvious. The 
needle of the syringe is made of iridio-platinum. 

Lithium Carbonate ; Lithii Carbonas, U. S. P. ; Li 2 C0 3 . 

A light white powder, odorless, and having an alkaline taste. It 
is soluble in 75 parts of water and readily soluble in carbonated 
water. 

Average Dose. — 7V 2 grains (0.5 Gm.). 

Lithium Citrate; Lithii Citras, U. S. P., B. P.; Li 3 r ,H-0 7 + 
4H 2 0. A white, odorless powder, having a cooling, alkaline taste. 
It is soluble in about 3 parts of water. Average dose, 7 1 / 2 grains 
(0.5 Gm.). 

Lithium Salicylate; Lithii Salicylas, U. S. P.; LiC 7 H 5 3 . A 
white, odorless powder, having a sweetish taste. It is very soluble 
in water. Average dose, 15 grains (1 Gm.). 

Lithium Citrate, Effervescent; Lithii Citras Effervescens, U. S. 
P., B. P. A granular effervescent salt, containing 5 percent of 
lithium citrate. Average dose, 120 grains (8 Gm.). 

Hexamethylexamix ; Hexamethylenamina, U. S. P.; 
C 6 H 12 N 4 ; Urotropin ; Cystogen ; Aminoform ; Formix. 

It forms colorless, lustrous crystals, having a slight alkaline 
taste. It is soluble in 1.5 parts of water and 10 parts of alcohol. 

Average Dose. — 4 grains (0.25 Gm.). 

Citarin; Sodium Anhy dromethylen Citrate. It is a white 
granular powder, having a faintly saline taste and a slightly acid 
reaction. It is soluble in 1.5 parts of water. In the presence of 
alkalies it is split up in formaldehyd and sodium citrate. Average 
dose, 15 grains (1 Gm.). 

PlPERAZIX ; DlETHYLEXEDIAMIX. 

It forms colorless, -lustrous, very hygroscopic crystals, which are 
very readily soluble in water, forming strongly alkaline, but not 
caustic, solutions. 

Average Dose. — 7 1 / 2 grains (0.5 Gm.). 



ANTIPYRETICS. 393 

Lycetol, a piperazin tartrate, and sidonal, a piperazin quinate, 
have been lately introduced as substitutes for pure piperazin. 

For Gouty Pericementitis. 

J$l Hexamethylenaminas g ss (16.0 Gm.) 

Colchicine gr. ss (0.03 Gm.) 

M. f. tablet. No. Lx. 

Sig. : A tablet dissolved in a tumblerful of water five times 
daily. 



ANTIPYRETICS. 

Antipyretics or antifebriles, both meaning against fever, are 
remedies employed for the purpose of reducing increased bodily 
temperature. They incidentally act as sedatives and anodynes, 
and are frequently employed in dentistry to relieve neuralgia; 
hence they are sometimes referred to as antineuralgics or anti- 
nervins. 

The normal temperature of man is comparatively constant — 
that is, the changes vary in a very narrow limit. Normally, the 
body temperature ranges between 98.5° and 99.5° F. (36.9° and 
37.4° C). The external air has very little influence on the tem- 
perature of the human body. It is immaterial whether we are 
exposed to the broiling sun of the equator (120° F., 49° C.) or 
to the icy cold of Spitzbergen ( — 40° F., — 40° C.) ; our inner 
temperature of 99° F. (37.3° C.) remains unaltered. The regula- 
tion of the body temperature is controlled by specific nerves, 
although we are able by suitable protection — heavy or light cloth- 
ing, warm rooms or shady, airy, open spaces — to materially in- 
fluence the radiation of bodily heat. The regulation of heat- 
producing foodstuffs is of prime importance ; cold climates require 
easily combustible fats or other carbohydrates, while in 'the 
tropics we instinctively avoid a steaming dish of "pork and beans." 
A rise of temperature of the surroundings causes dilation of the 
peripheral vessels, which forces the warm blood to the surface to 
be cooled off, and the ready evaporation of perspiration from an 
increased action of the sweat glands cools the body surface. The 
combined process of heat production and regulation is based on 



394 PHARMACO-THERAPEUTICS. 

physiologic, chemic, and physical laws. An abnormally increased 
heat produced by physical exertion and unfavorable external con- 
ditions — high heat, humid atmosphere, etc. — may lead to over- 
heating of the body; 104° F. and even as high as 113° F. 
(40° to 45° C.) have been observed in sunstrokes. 

A rise in the body temperature is, in the majority of cases, the 
symptom of fever, provided this higher temperature is of a fairly 
constant nature. Fever is not a disease, but a pathognomonic sign 
of disturbance of the equilibrium of the organism as a whole. In 
most cases fever is the result of infection, although traumatic dis- 
turbances — subcutaneous fractures — may cause a so-called aseptic 
fever, which in its production is somewhat analogous to an aseptic 
suppuration. The causes of the increased temperature in fever 
have given rise to various theories; the present consensus of opin- 
ions seems to point to the fact that fever is an indication that the 
centers of heat regulation are gauged to a higher standard than 
that which is normally present in the body. Accepting this 
hypothesis, we may explain the causative factors of fever as fol- 
lows: Certain pyretogenic (fever producing) chemic substances 
act on the centers of heat regulation by interfering with the normal 
equilibrium of heat production and heat radiation, and as a con- 
sequence these centers are shifted to a higher plane and a higher 
constant body temperature is the result. The true antipyretics 
act on the higher gauged centers, and their influence causes the 
centers to return to their normal position. External influence on 
heat production and heat regulation do not interfere with the 
action of the true antipyretics. Indirect antipyretics — quinin, 
salicylic acid, etc. — as they are sometimes called, influence the heat 
centers partially, but they act principally on heat production and 
heat radiation. 

The pathologic significance of fever has kept pace with the 
spirit dominating medical practice. At one time it was thought 
that fever was a dangerous disease and had to be cured, and, again, 
it was looked upon as an expression of vis medicatrix naturse, a 
view which is at present favored by leading clinicians. Conse- 
quently fever should not be "treated" immediately. If, however, 
the organism, in its effort to combat an infection, produces an ab- 



ANTIPYRETICS. 395 

normal high temperature} it is the duty of the sensible practitioner 
to administer suitable antipyretics — to coax nature to return to her 
normal functions. Fever may damage the organism in various 
ways. Abnormal high temperature is imminently dangerous to 
the heart, and, furthermore, a high temperature causes increased 
metabolism, with loss of strength, as the destroyed albumin mole- 
cule can not be replaced with sufficient rapidity. The increased 
temperature is accompanied by a disturbed psyche ; the patient is 
fidgety, and sleeplessness and restlessness cause the loss of much 
valuable vital resistance. 

The action of antipyretics in general is confined to the central 
nervous system ; they reduce the temperature and incidentally act 
as sedatives and anodynes. 

Quinin Sulphate; Quinine Sulphas, U. S. P., B. P.; (C 20 H 24 
2 ) 2 .H 2 S0 4 +7H 2 0; Sulphate de Quinine, F. • Schwefel- 

SAURES CHININ, G. 

Source and Character. — It is the sulphate of the alkaloid 
quinin, obtained from the various species of Cinchona. It appears 
in white, silky, light, flexible crystals, or hard prismatic needles, 
colorless, and having a persistent bitter taste. It absorbs moisture 
from the air. It is soluble in 720 parts of water, 86 parts of alcohol, 
and 36 parts of glycerin; diluted acids increase its solubility in 
water. It is incompatible with ammonia, alkalies, lime water, tan- 
nin, potassium iodid, etc. 

Average Dose. — 4 grains (0.25 Gm.). 

Therapeutics. — Quinin is the sovereign remedy in malaria; 
here it acts as a specific. It is a protoplasm poison ; administered in 
therapeutic doses, it destroys the causative factors of malaria, the 
Plasmodia malarias,, without materially altering the protoplasm of 
the cells of the host. Quinin should be administered three to four 
hours before the typical malarial attack is manifested, so as to 
allow sufficient time for its absorption. It is a prompt prophylactic 
against this disease. Its action as an antiseptic on bacteria or their 
spores is very weak. It inhibits the migration of leucocytes, and 
for this reason Binz and Helmholz recommended it at one time as 
an antiphlogistic. Its local application based on this supposition, 






396 PHARMACO-THERAPEUTICS. 

was much lauded in the treatment of pyorrhea alveolaris. While 
it is true that quinin inhibits the migration of the white blood cor- 
puscles, and, as a consequence, retards the typical symptoms of in- 
flammation, it increases the spreading of the infection. When in- 
flammation, which is nature's curative agent against infection, is 
checked, the latter progresses unhindered on its path of destruction. 
Quinin acts on the central nervous system as an anodyne; it re- 
duces the irritability of the sensory nerves, and is used as an anti- 
neuralgic. In influenza and in septicemia it deserves to be recom- 
mended. Quinin is best administered in loose-filled capsules, in 
pills, or suspended in syrup of yerba santa. 

Aside from quinin sulphate, quite a large number of other quinin 
salts, artificial alkaloids, and a tincture and infusion of cinchona 
bark are medicinally employed. 

Acetylsalicylic acid, known as aspirin, and in a recent modifica- 
tion as novaspirin, is a prompt and valuable antipyretic and ano- 
dyne. It is specially recommended in neuralgic and rheumatic 
pain about the face and head. It is only slightly soluble in water, 
but readily soluble in alcohol. It is best administered in tablet 
form. Average dose, 7*/ a grains (0.5 Gm.). 

Salicylic acid and its many salts and synthetic substitutes — 
glycosal, salophen, salacetol — have been referred to under salicylic 
acid. 

Antipyrin; Antipxrina, U. S. P.; Phenazonum, B. P.; 
C^H 12 N 2 0; Analgesine, Antipyrine, F. ; Antipyrin, G. 

Source and Character. — It is a derivative of pyrazolon, and 
forms a colorless, almost odorless, crystalline powder, having a 
slightly bitter taste. It is soluble in less than 1 part of water and 1 
part of alcohol. It is incompatible with acids alkalies, tannin, 
salicylates, etc. 

Average Dose. — 4 grains (0.25 Gm.). 

Therapeutics. — Antipyrin is a general antiypretic and ano- 
dyne. It acts on the central nervous system, and reduces the higher 
gauged centers of heat regulation to their normal position. It is an 
effective remedy in neuralgia, migraine, lumbago, and sciatica. It 
should be given in strong doses from 4 to 8 grains (0.25 to 0.5 



ANTIPYRETICS. 397 

6m.), dissolved in water or in gelatin capsules. Some persons 
show a distinct idiosyncrasy to this drug, which is often accom- 
panied by skin eruptions. 

A number of other pyrazolon derivatives have appeared within 
the last decade, of which migrainin ? trigemin, and pyramidon are 
the best representatives. The latter is especially lauded in facial 
neuralgia and the various forms of toothache, and is given in 
7y 2 -grain (0.5 Gm.) doses. 

Acetanilid; Acetanilidum, U. S. P., B. P.; C 8 H 9 NO; Anti- 

FEBRINE, ACETANILIDE, F. ; ANTIFEBRIN, G. 

Source and Character. — It is the monacetyl derivative of ani- 
lin. It is a colorless, crystalline powder, odorless, and having a 
slightly burning taste. It is soluble in 180 parts of water, 2.5 parts 
of alcohol, and in chloroform and ether. It is incompatible with 
nitrous ether, bromids, iodids, phenol, resorcinol, and thymol. 

Average Dose. — 4 grains (0.25 Gm.). 

Therapeutics. — Acetanilid acts on the central nervous system 
as a powerful anodyne. In large doses it acts as a blood poison by 
forming methemoglobin, which manifests itself in pronounced 
cyanosis. Acetanilid forms the base of many "headache" powders 
and of many copyrighted pharmaceutic preparations generically 
known as "coal tar derivatives." Many cases of poisoning resulting 
from the indiscriminate use of these compounds are on record. 
Acetanilid is a prompt antipyretic ; it is best administered in pow- 
der (capsules, tablets, or cachetes), in alcoholic solutions, or as the 
compound powder of acetanilid, pulvis acetanilidum compvsitus, 
U. S. P. The average dose of the latter is 7 1 / 2 grains (0.5 Gm.) . 

Acetphenetidin ; A cetphenetidinum , U. S. P. ; Phenacetinum, B. 
P.; C 10 H 13 NO 2 ; Phenacetin. It is a derivative of anilin and closely 
related to acetanilid, but it is much less poisonous than the latter. 
It is a white crystalline powder, having no odor or taste. It is 
soluble in 925 parts of water and 12 parts of alcohol. It is best 
administered in powder form. It is a prompt antipyretic and ano- 
dyne, and its toxic side action, as compared with acetanilid, is 
decidedly less. Average dose, 7 1 / 2 grains (0.5 Gm.) 



398 PHARMACO-THERAPEUTICS. 

A number of other anilin derivatives are known — lactophenin, 
phenocoll, kryofin — and are given in about the same doses as 
phenacetin, but apparently do not possess any therapeutic advan- 
tages over the latter. 

For Facial Neuralgia. 

$. Phenacetin. 3 j (4.0 Gm.) 

M. f. pulv. No. viij 
Sig. : A powder every three hours. 



ORGANO AND SERUM THERAPY. 

Organo Therapy. 

The immense strides which have been made within the last few 
decades in general therapeutics have occasioned the utilization of 
animal tissues or their products for medicinal purposes. Their 
application is known as organo therapy. 

The use of animal drugs for medicinal purposes is probably as 
old as the history of the human race; organic secretions, parts of 
the animal, and, in some instances, the whole animal have always 
played with our remotest ancestors a more or less important role 
in curing diseases. The use of testicles against impotence, the gall 
of snakes, birds, fishes, etc., in diseases of the brain, or the bile of 
a snake or scorpion are accredited with high curative power in 
most of the medical records of the early civilized nations of the old 
world. The tendency of medicinally applying organic prepara- 
tions seems to center in the natural desire to cure a diseased organ 
by an extraction, decoction, tincture, or similar preparation of the 
same organ or its secretion obtained from some animal. So, then, 
we find that in diseases of the urinary organs the drinking of 
urine, in the bite of a rabid dog the stewed gall of a dog affected 
with hydrophobia, and in the presence of intestinal worms decoc- 
tions of worms in oils were highly lauded. The empiric evolution 
of therapeutic applications was apparently based on the suppo- 
sition to cure like things by like, a doctrine which many centuries 
later was adopted as similia similibus curantur by the homeo- 



ORGANO AND SERUM THERAPY. 399 

pathic school. Modern organ o therapy received its scientific in- 
centive from the work of Brown-Sequard by the presentation of 
his epoch-making essay relative to the use of the extract of testicles 
before the French Academy of Science in 1889. He based his 
conception on "internal secretions," which, as he claims, continu- 
ously supply the blood and lymph stream with certain materials 
intended to perform important functions in the cycle of living 
processes. Claude Bernhard had called attention to the secretion 
of the "ductless glands," as well as to certain other glands, which 
produce specific bodies. These bodies are probably in the nature 
of ferments, and they are absolutely essential for the maintenance 
of bodily functions. According to Hansemann it seems that an 
altruistic relationship exists between the various types of tissue 
cells. One type of cells will undertake the work of other types, 
and, vice versa, these other types will do the work of the one type 
of cells. This conception is closely allied to the theory of Fraser 
regarding the formation of antitoxins in the bodies of those ani- 
mals which produce a definite poison that is fatal to other animals, 
but not to themselves. 

The thyroid gland is a typical representative of a ductless gland. 
The administration of the dried, powdered gland or its extract in 
diseases which are connected in one way or another with this 
gland — myxedema, goiter, cretinism — has produced most remark- 
able results. Its administration must be continued for a long 
period, often throughout life, to prevent relapses. The thyroid 
gland contains in its cell a peculiar globulin known as thyroglobu- 
lin. The active constituent of this body seems to be an organic 
form of iodin — iodothyrin. Its greatest influence is manifested 
by its action of metabolism ; it increases the waste of proteins and 
the oxidation of fats in the body, with an unusually large amount 
of urine excretion. 

The extract of the testicles, or an alkaloid obtained therefrom 
and known as spermin, is recommended in cases where the dimin- 
ished sexual powers call for a stimulation of their activity. The 
extract of bone marrow and of the spleen are recommended in per- 
nicious anemia to increase the formation of erythroblasts. The 
thymus gland or its extract has been advised in exophthalmic 



400 PHARMACO-THERAPEUTICS. 

goiter. An extract of the pituitary body has been advocated in dis- 
eases associated with hypophysis. Fresh and purified ox gall is 
employed as a cholagogue, purgative, and intestinal antiseptic. 
The extract of the suprarenal gland or its alkaloid, adrenalin, has 
been suggested in Addison's disease, a peculiar disease of these 
glands. The very remarkable property of adrenalin to increase 
the blood pressure, and incidentally cause local anemia when 
applied locally or injected hypodermically, is referred to under 
Suprarenal Glands. 

Serum Therapy. 

The introduction of bacteriology into general medicine has ex- 
ercised a most powerful influence on the biologic conception of 
infectious diseases. The discovery of specific organisms as the 
causative factors of specific infectious diseases has completely 
changed the therapeutic application of remedial measures by cre- 
ating a definite method of treatment known as serum therapy or as 
biologic therapeutics. 

The bacteria of certain infectious diseases invade the body only 
in definite places — as diphtheria in the throat — but nevertheless 
the reaction of the entire body to this disease indicates that specific 
products of these causative factors must have reached the blood. 
Infection is more or less always accompanied by intoxication ; the 
latter is the result of the absorbed specific poisons. The isolation 
of these poisons (toxins of bacterial origin, especially from putre- 
fying protein substances) led to the discovery of ptomains — cadav- 
erin, putresein, neuridin, etc. These peculiar alkaloid-like bodies 
are, however, not the specific cause of the disease, as it was soon 
found that the real poisons are ferment-like bodies known as bac- 
terial toxins. These compounds are very powerful poisons, and 
the smallest quantity will produce toxic symptoms which are not 
equaled in their intensity by any other known substance. The 
toxins differ from other poisons in so far as they require a certain 
period of incubation before they develop their powerful destruc- 
tion, and they are not necessarily equally poisonous to all animals. 

When an animal is inoculated with a certain pathogenic organ- 



ORGANO AND SERUM THERAPY. 401 

ism without producing specific symptoms of the disease, it is said 
to be immune. This peculiar condition is referred to as natural 
immunity when the animal does not react to the inoculated organ- 
ism without a preliminary preparation, and as acquired immunity 
when it does not react after it has passed through a mild attack of 
the disease, or when it is artificially prepared against it by injec- 
tion of certain substances. Immunity is the result of the action of 
substances present in the blood of the individual — the alexins. If 
a person has passed through a mild attack of measles, small pox. 
scarlatina, etc., he is usually immune for a shorter or longer period 
against a future attack of these diseases. Weak, attenuated cul- 
tures of bacteria, when inoculated into the body, will accomplish 
the same results. Attenuated cultures may be prepared by ex- 
posing the ordinary virulent pure cultures to light, heat, chemic 
agents, etc., or by passing them through the body of an animal 
which is especially rich in alexins. The principle is based on the 
original empiric vaccination with cow pox against small pox as 
inaugurated by Jenner in 1706. After an active immunization 
the blood is found to contain specific antibodies, which act against 
the invading bacteria or their poisonous products in the nature of 
an antidote. These antibodies are substances of an albuminous 
character, and are relatively very weak compounds, especially to 
heat, cold, light, chemicals, etc. It has been found that when 
blood obtained from animals which is especially rich in these anti- 
bodies — that is, blood from animals which are actively immunized 
— is injected into other animals which have not been previously 
treated, these latter animals will become immune against the 
specific organism. This form of immunization produces passive 
immunity. Passive immunity lasts only a short time— about three 
weeks in diphtheria — while active immunity may last the entire 
life. Passive immunization is sometimes employed as a prophylac- 
tic against a specific disease, but principally as a curative agent in 
the early stages of infectious diseases. The injected antibodies will 
attack the toxins present in the blood; they act as true curative 
agents, and are known as antitoxic sera. The antitoxins may act 
in two ways — they may be specific antibodies against a specific 
bacterium (always against only one species), or they may act as 



402 PHARMACO-THERAPEUTICS. 

antibodies against the toxins present in the blood of the infected 
individual. The antitoxins are true antidotes; they combine with 
the toxins somewhat in the same manner as an acid will neutralize 
an alkali. Aside from the explanation regarding the action of 
antitoxins and other bactericidal substances as presented by Behr- 
ing, Kitasato, Nuttall, Pfeiffer, Ehrlich, and others, the phagocytes 
have been held responsible by Metchnikoff for the mechanism of 
immunity. He claims that the phagocytes are certain white 
blood corpuscles, which act as digesters, scavengers, and chief de- 
fenders against the invading bacteria. "The diapedesis of the 
white blood corpuscles, their migration through the vessel wall 
into the cavities and tissues, is one of the principal means of 
defense possessed by an animal. As soon as the'infective agents 
have penetrated into the body, a whole army of white corpuscles 
proceeds toward the menaced spot, there entering into a struggle 
with the micro-organism." 1 The action of the phagocytes may be 
intensified or diminished in various ways. To accomplish this 
purpose certain other substances present in the blood of the indi- 
vidual* must be determined. These substances are known as 
opsonins, and Wright has devised an ingenious method for de- 
termining the amount of opsonins present in the individual, or, as 
he refers to it, to establish the opsonic index. 2 The opsonins (to 
prepare for food) are substances which, in some unknown man- 
ner, act on the bacteria and prepare them for digestion by the 
phagocytes. The opsonic index indicates whether the opsonic sub- 
stances present in the blood are above or below the normal stand- 
ard. The treatment of infectious diseases by opsonins has found 
many admirers among clinicians, and it has been recently intro- 
duced by Goadby 3 for the treatment of pyorrhea alveolaris. The 
technique of preparing the opsonic index and the treatment of 
pyorrhea with opsonins has been clearly set forth by Hecker. 4 

A recent interesting hypothesis regarding the existence of bac- 
terial substances in the body fluids has been made by Ehrlich, and 
is known as side-chain or receptor theory. While the doctrine of 



1 Metchnikoff: Immunity, 1905. 

2 Wright: Proceedings of the Royal Society of England, 1903. 

3 Goadby: British Dental Journal, 1907, p. 885. 

4 Hecker: Items of Interest, 1909, p. 188. 



ORGANO AND SERUM THERAPY. 403 

receptors is largely an assumption, it is nevertheless a most in- 
genious attempt to explain the action of antitoxic sera, and it may- 
aid as an incentive for further research in this interesting field of 
therapeutics. 

The antitoxic sera are principally administered by hypodermic 
injection ; they enter the blood and combine directly with toxins of 
the disease, thereby destroying poison. The toxins of infectious 
disease remain only a very short time in the circulation. They 
usually combine more or less quickly with the protoplasm of 
such cells for which apparently they possess an affinity, and then 
they are reached only with difficulty, or not at all, by the anti- 
toxins; hence the importance of an early injection of the latter is 
apparent. 

The various sera, bacterial vaccines, and similar biologic prod- 
ucts are at present manufactured on a large scale. To insure uni- 
formity of these products, and to prevent their indiscriminate 
compounding by the inexperienced, the United States government, 
after a careful investigation of the respective laboratories, has 
licensed certain manufacturers to prepare these various biologic 
products. 

An antitoxic serum against diphtheria, which has been used 
with very gratifying results, a serum against tetanus, and various 
sera against tuberculosis are universally employed at present in 
general medicine. Of the many vaccines, those of the staphylo- 
cocci, streptococci, gonococci, lactic acid bacilli, and a few others 
are the principal representatives. The pus vaccines and a lactic 
acid culture known as massolin are used at present in the treat- 
ment of dental lesions. The pus vaccines are employed hypo- 
dermically, according to Wright's method, after establishing the 
opsonic index, while massolin is used with a spray in chronic 
antral diseases. For the latter purpose it is recommended to inject 
the lactic acid culture in 1-cubic-centimeter doses with an atomizer 
every other day into the diseased sinus until pus formation ceases. 
Based on the same principle, sour milk has been used for the above 
purposes by Lohman some years ago. Recently a culture of the 
bacillus pyocyaneus, known as pyocyanase, is recommended by 
the above author in the local treatment of pyorrhea alveolaris. 



404 PHARMACO-THERAPEUTICS. 

The application is simple : After the preliminary cleansing of the 
mouth and the removal of calcareous deposits from the teeth, etc., 
pyocyanase is injected into the pus pockets, and the latter are cov- 
ered with an unctuous paste to temporarily prevent its washing 
away by the saliva. The remedy may be applied once or twice 
a day, according to the severity of the case, until pus formation 
ceases. 

The application of serum therapy in dentistry is as yet in its 
infancy; the results obtained with biologic therapeutics in gen- 
eral medicine are, however, very encouraging, and it is but reason- 
able to apply the same principle in diseases of the oral tissues. 



PART III. 
PHYSICAL THERAPEUTICS. 



ARTIFICIAL HYPEREMIA. 

In the treatment of diseases a variety of methods and measures 
are employed as remedial agents which can not be properly classi- 
fied as drugs if we restrict the latter term to organized substances 
which, when introduced into the living body, counteract disease. 
A remedy, in the broadest sense of the term, is anything which 
cures, palliates, or prevents disease, and, consequently, therapeutics 
comprise the utilization of all means and methods which are em- 
ployed for the purpose of relieving the sick and favorably modify- 
ing the evolution of disease — i. e., the art of healing. In addition 
to the use of drugs and surgical procedures, a number of mechan- 
ical and physical forces are employed, which, for the want of a 
better term, we have classified as physical therapeutics, and they 
include Bier's artificial hyperemic treatment, massage, heat, cold, 
light, electricity, etc. 

The pathologic study of infectious diseases and their treatment 
has been completely revolutionized within the last few decades. 
The primary cause of this change may be attributed to the re- 
markable development of the science of bacteriology, and its in- 
troduction into biology marks a conspicuous epoch in the scientific 
progress of medicine. Louis Pasteur was the founder of bacteri- 
ology. Joseph Lister introduced it as "antisepsis" into surgery, 
and when Robert Koch, in 1876, brought forward convincing evi- 
dence that certain specific micro-organisms were the cause of 
certain specific diseases, the old superstitious belief in miasms, con- 
tagion, and spontaneous generation received its death blow. Bac- 
teriologic research revealed the important fact that the body 
fluids possess the power of destroying or neutralizing poisons 

405 



406 PHYSICAL THERAPEUTICS. 

which enter into the body from without. It is rather remarkable 
that the developmental study of diseases selected the most difficult 
ones — anthrax, hydrophobia, diphtheria, tuberculosis, etc. — for its 
initial investigation, while ordinary, simple infection, until lately, 
has been grossly neglected. It is true that certain sera have been 
prepared for the purpose of combating the invasion of the pus 
producing micro-organisms, but they have in reality been of little 
benefit. 

Within recent years a new remedial measure has been intro- 
duced into therapeutics for the purpose of combating infectious 
diseases which is so surprisingly simple, and yet so very definite 
in its final result, that one can only wonder why it was not dis- 
covered a long time ago. The object of the treatment consists 
in the increased utilization of the natural resources which the body 
possesses in the fight against local infection, and is known at pres- 
ent as the hyperemic treatment of Bier. Bier founded his con- 
ception of this treatment on observations which he had made in 
the clinic of Rokitansky in Vienna. He had repeatedly pointed 
out that a lung with a chronic obstructive hyperemia resulting 
from some valvular insufficiency of the heart would not, in the 
great majority of cases, be attacked by tuberculosis. On logical 
reasoning Bier applied the same principle with surprisingly good 
results in the treatment of chronic infections of the joints. In 
due time the technique of this treatment, depending largely upon 
the construction of suitable apparatus, had to undergo many modi- 
fications ; but, even with the remarkable increase of the scope of its 
utilization, its general application is still in its infancy. 

According to Meyer-Schmieden, 1 the aim of Bier's hyperemic 
treatment is to bring about "the increase of the beneficial inflam- 
matory hyperemia resulting from the fight of the living body 
against invasion," and the most important principle underlying 
this treatment is that "the blood must continue to circulate — there 
must never be a stasis of the blood." In German, Bier calls his 
treatment Stauungshyperamie, 2 a term which expresses the cause 
as well as the effect. Stauung, translated into English, means 



1 Willy Meyer-Schmieden: Bier's Hyperemic Treatment, 1908. 

2 Bier: Hyperamie als Heilmittel, 1903. 



ARTIFICIAL HYPEREMIA. 407 

stowing. Many interpretations of the German term have been at- 
tempted — as congestive, induced, artificial-active and artificial-pas- 
sive, or artificial-arterial and artificial-venous hyperemia, and 
sometimes, although an absolutely false translation, stasis hyper- 
emia. As yet no definite term has been adopted by the English- 
speaking profession, and, as we have so far followed the trend of 
thought as outlined by Meyer-Schmieden, we adopt their sugges- 
tion and use the term "obstructive hyperemia" in the following 
pages. 

Before entering into the philosophic conception of obstructive 
hyperemia according to Bier, it is probably well to rehearse in a 
preliminary way the significance of inflammation from a modern 
pathologic point of view. 

At present it is generally conceded that inflammation is not a 
disease, but that it is the local defense of the tissues against an 
injury, manifesting itself by more or less pronounced symptoms — 
as redness, heat, swelling, pain, and impaired function. The most 
important changes occur in the blood vessels, which are distended 
by an increased influx of blood that is very quickly displaced by 
a retarded afflux. The white corpuscles conglomerate in bunches 
near the vessel wall, especially in the veins and capillaries, while 
the red blood corpuscles keep more to the center of the blood 
stream. The leucocytes and the lymphocytes now pass between 
the endothelial cells through the vessel walls of the veins and 
of the capillaries, but not of the arteries. This wandering of the 
white corpuscles — diapedesis — is accompanied by the transudation 
of blood serum, which fills the surrounding tissues, causing an 
edematous swelling. Later on the red blood corpuscles follow, but 
they migrate hi very much smaller quantities. The nature of 
the transudation, the quantity of the blood corpuscles, and the 
admixture of foreign bodies determine the character of the in- 
filtration, as it may be a serous, fibrinous, purulent, hemorrhagic, 
or croupous exudate. Another important, but as yet less recog- 
nized, symptom of inflammation is the increased osmotic pressure 
within the infiltrated area. Hamburger 1 and others have shown 



1 Manninger: Heilung Lokaler Infectionen mittelst Hyperamie, Wurzburger Abhandlungen, 
Vol. VI, No. 6. 



408 



PHYSICAL THERAPEUTICS. 



that the normal osmotic pressure of the tissue fluids amounts to 
about 7.5 to 7.9 atmospheres, which, when expressed relative to 
the freezing point of a physiologic salt solution, equals 0.55° to 
0.57° C. Under normal conditions the osmotic pressure is 
promptly regulated by the organism ; probably, according to Mas- 
sart, through specific nerves— that is, the normal equilibrium of 
the isotonic index of the blood and tissue fluids remain station- 
ary. In pathologically altered tissues the composition is continu- 
ally interfered with, and usually results in a marked increase of 
the osmotic pressure — hyperisotonicity. Increased osmotic pres- 
sure produces pronounced morphologic changes in the cells, and 
is largely responsible for the resultant pain, followed by inflam- 
mation, within the affected area. According to Bitter 1 the va- 
rious changes in tissues, if a simple abscess is taken as an ex- 




FlGURE 51. 

Schematic Drawing 1 of an Abscess. The abscess and the surrounding infiltrated area show 
the various degrees of osmotic pressure, a, abscess; b, hyperemic zone; c, manifest edema; 
d, latent edema. 

ample, may be described as follows: In the center of the pus 
cavity the osmotic pressure may reach a density of 0.6° to 1.4° C. 
(0.56° being normal), but in the surrounding hyperemic zone 
the pressure is less, gradually diminishing in the manifest edema, 
and becoming less and less toward the periphery until normal pres- 
sure is reached. Aside from these quantitative changes within the 
inflamed area, qualitative changes of the constituents of the exu- 
dates undoubtedly have some important significance. The nature 
of these latter changes is at present too obscure to allow any defi- 
nite statements to be made. 

Whenever living tissue is injured — whether by mechanical, 



J Schade: Miinchner Medizinische Wochenschrift, 1907. 



ARTIFICIAL HYPEREMIA. 409 

thermal, or chemic means — the system at once tries to protect 
itself against the invading foe by an increased rush of blood into 
the injured area, resulting either in a victorious fight — complete 
resolution, or in a surrender to the enemy — necrosis. 

Local hyperemia, which is the forerunner of acute inflamma- 
tion, results from an increase in the quantity of blood in the in- 
jured part. If it is due to an increase in the flow of blood, it 
is referred to as arterial or active hyperemia, while, if resulting 
from an obstruction which retards its outflow, it is known as 
venous or passive hyperemia. In active hyperemia the involved 
area is bright red in color, and the temperature is slightly 
elevated and usually accompanied by a marked swelling. Passive 
hyperemia manifests itself by a bluish-red color (cyanosis) of the 
involved area, with a somewhat lessened temperature. The veins 
are distended, and an edematous swelling is soon observed, result- 
ing from the transudation of the various constituents of the 
blood. The cardinal factors of the early stages of inflammation 
. which bear a direct relationship to the proper conception of Bier's 
hyperemic treatment are the migration of leucocytes, the transu- 
dation, of serum, and the increased activity of the fixed tissue 
cells. At present it seems to be proved that the therapeutic 
benefits derived from hyperemia find an explanation in the bac- 
tericidal action of the blood serum. To enter into a detailed dis- 
cussion of the nature of these protective substances — whether they 
be called alexins, antibodies, lysins, opsonins, or phagocytes — is 
of no consequence in our present consideration of the subject. 
Let it suffice to say that nature utilizes, so far as we know, three 
important principles of self-protection against local infection — 
preparation of the way for transudation of the serum, positive 
chemotaxis, and increased activity of cell proliferation. Quite a 
number of theories have been promulgated to explain the nature 
of the defensive properties of hyperemia. Buchner claims that the 
increase of the leucocytes and, in consequence, the alexins are 
the factors. Hamburger believes that the increased amount of car- 
bonic acid in the blood as a sequence of the congestive hyperemia 
is responsible. The same views are shared by Chantemesse 1 and 



1 Chantemesse: Academie de Medicine, 1903. 



410 PHYSICAL THERAPEUTICS. 

Lubarsch. 1 Notzell favors this view, provided it is restricted to 
recent exudations, while Metchnikoff, supported by Leyden, 
Lazarus, and others, believes that the phagocytotic action of the 
leucocytes is the predominating factor. Be that as it may, the 
facts remain that hyperemia is the essential factor which nature 
provides in a more or less pronounced degree to combat local in- 
fection, and that we owe it to Bier to have therapeutically utilized 
this very same principle, artificially provided, to assist nature in 
warding off disease by producing inflammation. It seems para- 
doxical to speak of warding off disease by providing inflamma- 
tion. From a therapeutic point of view, it has been our aim to 
treat inflammation by antiphlogistic measures, while the Bier 
treatment apparently advocates the opposite — irritants. An ulti- 
mate analysis of the action of antiphlogistics will convince us, 
however, that in reality they act as irritants by increasing the 
factors which are productive of inflammation instead of diminish- 
ing them. Bier has rightly said that the laity is not so foolish 
as to always use for centuries and centuries the same remedies if 
they were of no value, or even dangerous. The layman ripens 
the abscess with a bread and milk poultice, or some similar irri- 
tant. From the earliest times heat, in the form of a poultice 
or fomentation, has been applied by means of heated rags, stones, 
china, etc., and has always ruled supreme in the treatment of local 
infections. Tincture of iodin paint, the hot-water bottle or the 
ice bag, the modern alcohol poultice or the Priessnitz bandage, 
the therapeutic lamp or the electric light bath, and massage ac- 
complish in reality one and the same purpose — they produce cer- 
tain forms of artificial hyperemia. Many of these remedies act 
only by counterirritation, producing a secondary inflammation in 
order to relieve the primary irritation. Bier has selected two types 
of direct mechanical excitants to produce two definite forms of 
hyperemia — the elastic bandage or the suction cup for the pro- 
duction of passive or venous hyperemia, and hot air for the pur- 
pose of rushing an accelerated blood stream into the tissues by 
active or arterial hyperemia. Occasionally these two forms of 
artificially produced hyperemia are so closely blended as to make 



1 Lubarsch: Allgemeine Pathologie, 1905. 



ARTIFICIAL HYPEREMIA. 411 

it impossible to draw a definite line of demarcation. Both means 
are very powerful therapeutic agents, and consequently their cor- 
rect application as to degree and duration requires a delicate 
technique in order to produce beneficial results only and not do 
harm. 

The advantages of hyperemic treatment over other therapeutic 
procedures are manifold. Some of these advantages are suppres- 
sion of infection and avoidance of suppuration, diminution of 
pain, and culmination of pathologic processes; large incisions 
into abscessed cavities may be entirely dispensed with; simple 
punctures, which naturally heal quicker, leaving very small or no 
scars, are usually sufficient for drainage by the suction cup. In 
the very early stages an artificially increased inflammation may 
successfully abort an incipient infection, and in already existing 
suppuration the processes of demarcation and final resolution are 
materially hastened. 

The bactericidal function of congestive hyperemia has been 
fairly well established by carefully conducted experiments. 
Notzel has shown that an injection of virulent cultures of strepto- 
cocci into the extremities of animals subjected to a powerful con- 
gestive hyperemia would do little harm, while the same injection 
into control animals invariably produced death. It is furthermore 
sufficiently proven by experimental work, as well as by clinical 
experience, that active hyperemia as produced by direct heat ma- 
terially increases the absorption of watery and water-soluble ma- 
terials by the capillaries, and not by the lymph vessels, as was 
formerly believed, all solid and non-water-soluble liquids being 
absorbed solely by the lymphatics. 1 These two factors deserve 
to be seriously considered by the dental surgeon who uses such 
poisons as cocain, adrenalin, etc., for injecting into the gum tis- 
sue. Absorption is lessened during hyperemia, and it is increased 
after the obstruction is removed. 

Local hyperemia exerts a definite solvent or softening power 
upon exudates which may have collected about joints or in the 
tissues — as blood clots, joint stiffness, phlegmonous infiltration, 
etc. It favorablv influences nutrition, and it seems to be a well- 



1 Mislowitzer: Berliner Zahnarztliche Halbmonatsschrift, 1908, p. 194. 



412 PHYSICAL THERAPEUTICS. 

established fact that the formation of callus, especially the amount 
of calcium salts, in the repair of broken bone is materially in- 
creased. 

Methods of Inducing Hyperemia. 

The Elastic Bandage.— The oldest and most favored method 
of inducing obstructive hyperemia is the elastic bandage. The 
bandage is usually made of soft rubber, but for dental purposes a 
bandage made of garter elastic is preferable. The material 
should be about three-fourths to one inch wide and about eighteen 
or more inches in length, with a hook at one end and a number 
of eyes on the other. In general surgery the bandage is usually ap- 
plied upon the extremities, and in dental surgery it is used around 
the neck for the purpose of producing obstructive hyperemia of the 
head, the superficial veins being very amenable to this procedure. 
A few simple, but important, rules govern the successful tech- 
nique of the application. One must at all times feel the pulse 
below the place surrounded by the bandage, and the technique is 
correct if there is absolutely no increase of pain, and if there is 
visible hyperemia of the part subjected to this treatment. Begin- 
ners are very apt to place the bandage too tightly. The bandage 
must partially obstruct only the superficial veins, and there must 
never be an increase of pain. The bandage is placed about the 
neck below the larynx. It should feel somewhat like a. tight- 
fitting collar, but it must never produce any degree of discom- 
fort, and the patient is the best judge of the proper fit. Its action 
may be increased by placing upon the jugular vein a pledget of 
soft cloth. If the bandage should irritate, a strip of flannel may 
be placed under it. Patients suffering from arterio-sclerosis re- 
quire special care. When treating acute inflammatory conditions 
about the head, a slight edema may be easily and safely pro- 
duced. Under no conditions must the obstruction be so great as 
to quickly produce a dark, bluish-red color or red blotches. The 
tissues located distally of the bandage must have a slight bluish- 
red, but never a white, appearance. Soon after the bandage is 
adjusted the focus of acute inflammation will show an increase 
in the cardinal symptoms — marked redness, heat, and swelling, 



ARTIFICIAL HYPEREMIA. 413 

but with a slow, definite diminution of pain. The latter decreases 
with the increase of the edema. It should be remembered, how- 
ever, that obstructive hyperemia does not and will not abort an 
abscess. If pus is present, the old Hippocratian postulate, ubi pas 
ibi evacuatio (where pus is it must be evacuated) , should be rigidly 
complied with, even if Bier's treatment is to be used to advantage, 
or, as Meyer-Schmieden rightly state, "the knife takes care of the 
pus — h\peremic treatment fights the inflammation." The bandage 
placed about the neck for the purpose of combating acute inflam- 
mation should remain in position from twenty to twenty-two 
hours per day, when it should be removed to allow the slight 
edemic condition to pass away. Chronic affections require shorter 
applications, about two to four hours per day having been found 
sufficient. The correctly adjusted bandage can be worn with 
perfect comfort and safety during sleep. 




Figure 52. 
Suction Cup for Alveolar Abscesses about the Gums. 

The Suction Cup. — The suction cups used for the purpose of 
producing congestive hyperemia are made of glass, representing 
various modifications of the old-fashioned cupping glass. De- 
pending upon the various surfaces of the body, bell-shaped cups 
of many sizes, or tubes, or boot-shaped vessels provided with a 
nozzle, are employed, and may be procured from surgical depots. 
Hyperemic treatment in the sense of Bier, as applied to dentistry, 
is as yet practiced to a very limited extent if we are permitted to 
judge from the scarcity of the literature on this subject, and con- 
sequently the special apparatus needed for dental work have to 
be, to a large extent, home-made. The larger cups intended for 
work on the external surfaces of the jaws may be procured from 
the depots, while the small tubes intended for the oral cavity are 
readily made from glass tubing by bending and shaping it to 



414 



PHYSICAL THERAPEUTICS. 



the proper angles over a Bunsen flame. The end of a soft 
glass tube of suitable size is held in the hottest part of the flame 
with the left hand, and continuously rotated to insure uniform 
heating, until it becomes soft. A heated excavator shank is 
now held against this edge at the proper angle, and thus the lip 
of the tube may be enlarged and its edge turned over. By heat- 
ing the tube beyond the cup-shaped enlargement, the correct 
bend of the tube may be easily obtained. 

Suction is accomplished with strong rubber bulbs, or with the 
suction pump fastened to the nozzle of the cup with stout rubber 
tubing. The action of the suction pump is best illustrated by 




Figure 53. 
Suction Cups for Abscesses about the Cheeks, Lips, and Chin. 



the working of a bicycle pump, remembering, of course, that the 
reverse action of the pump is needed for suction. The author 
has found that the very best and simplest method of suction is 
readily obtained by utilizing the sucking action of the saliva ejec- 
tor of the fountain cuspidor. By means of a short piece of stout 
rubber tubing the suction cup is connected with a piece of glass 
tubing fastened to the joint of the saliva ejector, and, by regulat- 
ing the water pressure, suction of the desired degree is readily 
obtained, which is far superior to any other means of suction. All 
degrees of congestive hyperemia may thus be obtained with per- 
fect precision and greatest ease. 



ARTIFICIAL HYPEREMIA. 



415 



Therapeutic Indications. 

The practice of dentistry offers a wide and prolific field for 
the application of Bier's hyperemic treatment. The indications 
for its use are manifold, its technique is extremely simple, and the 
results obtained with it are so very gratifying that it deserves the 
highest recommendation. 




Figure 54. 

Application of the Elastic Bandage for the Production of Obstructive Hyperemia of the 
Head. The hyperemia is increased by placing a piece of soft cloth over the large veins of the 
neck beneath the bandage. 

Congestive Hyperemia With Elastic Bandages. — Conges- 
tive hyperemia by means of the elastic bandage is primarily indi- 
cated in all painful disturbances of the periosteum of the teeth 
and jaws. It is a well-known fact that as soon as the cheek 
swells — as soon as nature establishes congestive hyperemia in the 
involved area — the pain arising from an acute pericementitis will 



416 PHYSICAL THERAPEUTICS. 

cease. The painful periosteal disturbances arising from the dif- 
ficult eruption of a third lower molar, including the dangerous 
phlegmonous infiltrations about the angle -of the jaw and the 
glandular enlargement as a sequence of these traumatic or infec- 
tious injuries, as well as the many other forms of £)ericementitis, 
are especially amenable to this treatment. Pain following in- 
flammation or suppuration after the offending tooth has been ex- 
tracted is much benefited by the application of the bandage. In 
the various forms of fractures of the jaws the bandage materially 
mitigates the resultant pain and apparently exercises 'a beneficial 
influence on callus formation. Facial neuralgia is not influenced 
by congestive hyperemia. 

The technique of applying the bandage has been alluded to on 
page 415. The bandage should be continuously applied for about 
twenty hours, or twice each day for about ten hours each time, 
with an interval of two hours. It should be borne in mind that 
the bandage should be applied with just a sufficient degree of 
tightness not to increase the pain. It must never strangulate, 
but should produce a visible hyperemia in the parts under treat- 
ment. 

Treatment of Dental Lesions with the Suction Cup. 

According to the location of the lesion within the mouth, the 
proper suction cup or tube which sufficiently covers the inflamed 
area is selected, and a thin coat of vaselin is spread over its rim 
to insure better adhesion. The various forms cf suction cups 
have been referred to on page 413. Klapp, Bier's former assist- 
ant, and Witzel 1 and his assistant Hauptmeyer have devised cer- 
tain modifications of the cups so as to make them amenable to 
dental purposes. A useful small cup, especially serviceable for 
alveolar abscess treatment, is readily made by slipping a soft 
rubber polishing cup over the slightly enlarged end of an eye 
pipette. Hunter has advised a similar treatment, and speaks of 
it as follows: One of the rubber cups used for cleaning teeth 
and mounted on a mandrel is forced down flat against the gum, 



1 Witzel, J.: Eie Bier'sche Stauung und deren Anwendung als Heilmittel in dcr Zahnheil- 
kunde, 1903. 



■ 



ARTIFICIAL HYPEREMIA. 



417 



covering the fistula, and by removing the pressure from the cup, 
but keeping its edges in close contact with the gum, a suction is 
created, drawing the medicament through the abscess tract. If 




FlGUEE 55. 

Application of a Suction Cup over the Sinus of an Alveolar Abscess. 

syphon suction is not available, a stout rubber bulb slipped over 
the end of the cup or tube answers the purpose. If the cup is 
used in connection with the syphon of the fountain cuspidor, a 



418 



PHYSICAL THERAPEUTICS. 



U-shaped piece of glass tubing is inserted between the syphon and 
the cup proper to act as a receptacle for pus and blood. The 
suction must be of a mild degree, and is applied but once a day 
for about three-quarters of an hour — five minutes at a time, with 
three minutes' intermission, repeating the suction five to six 
times at the same sitting. If this treatment is applied in the 




s 



Figure 56. 

Hyperemic Suction Cup Applied to a Chin Fistula. This fistulous opening was caused by a 
dead pulp in a lower incisor. 

early stages of pericemental trouble, the formation of an abscess 
may be readily aborted, provided the root canal of the affected 
tooth has been properly cleansed and drained, and suitable anti- 
septics have been applied. If suppuration has already set in, the 
abscess is simply punctured, and no large incision is necessary. 
The cup is now applied for further treatment, which must be 
continued until all infiltration has subsided. After the second 



ARTIFICIAL HYPEREMIA. 



419 





Figure 57. 



■i. .... . . A 



Suction Cup Applied to a Fistula on the Cheek near the Border of the Mandible. The abscesa 
is caused by a dead pulp in a lower molar. The cup is connected with the syphon of the 
fountain cuspidor. 



420 PHYSICAL THERAPEUTICS. 

treatment, usually nothing but blood is drawn away by the cup, 
and, if some strong antiseptic — as a solution of iodin in cresol — 
is placed into the root canal, it is readily sucked through the 
fistula. 

If an alveolar abscess opens on the face, the treatment by the 
suction cup is practically the same, only that suitable larger cups 
have to be used. If a crust has formed over the sinus, it must 
be removed before suction is started. A simple ointment dress- 
ing held in place by collodion is applied after the treatment. 
Abscesses treated in this manner practically leave no disfigura- 
tion on the face after cicatrization has set in. 

In the treatment of an acute abscess without a fistula (blind 
abscess) , suction also is employed with marked benefit. The root 
canal must be thoroughly cleansed, and the foramen is slightly 
enlarged before suction is started. Two methods of applying the 
suction cup are in vogue — a large hypodermic needle is cemented 
into the root canal with temporary stopping, or a short thick- 
walled rubber tube is drawn over the tooth. Either appliance is 
now connected by means of glass and rubber tubes with the rub- 
ber bulb or the syphon. Dill 1 and Schroder 2 have advised the 
use of a powerful metal syringe (aspirator) for this treatment, 
while Miller 3 praises the syphon of the fountain cuspidor as a 
good suction medium. 

Congestive hyperemia applied in the treatment of certain 
stages of pyorrhea alveolaris is of marked benefit. Specific ap- 
paratus are needed for each case, but, as they are difficult to 
adjust, their general application is limited. Schroder 4 has pub- 
lished some preliminary reports concerning this method of treat- 
ment, but the apparatus used by him was rather cumbersome. 
A special suction cup has to be constructed for each individual 
case. A cup for the anterior lower teeth may be made of hard 
vulcanite, with a rim of soft velum rubber, from a model of the 
involved parts, or a cup may be made from an impression taken 
in modeling compound. Suitable trays for such work are con- 



1 Dill: Schweizer Vierteljahrsschrift fiir Zahnheilkunde, 1901, No. 3. 

2 Schroder: Deutsche Monatsschrift fiir Zahnheilkunde, 1907, p. 356. 

3 Miller: Lehrbuch der Konservativen Zahnheilkunde, 1908. 

4 Schroder: Loc. cit. 



ARTIFICIAL HYPEREMIA. 



421 



structed and used as follows f The handle and heels of « lower 
Angle impression tray are cut off ; a hole a quarter of an inch wide 
is drilled in the center of the tray, and a piece of brass tubing 
three-eighths of an inch long is soldered into the hole; the cup 
is now trimmed so as to fit the involved area as nearly as pos- 




FlGURE 58. 

Hyperemic Suction Apparatus for the Treatment of Pyorrhea Alveolaris. A specially pre- 
pared impression cup for the lower incisors, lined with a rim of softened impression compound 
and connected hy a piece of rubber tubing- with a suction pump. 



sible; the tray is filled with modeling compound and an impres- 
sion is taken of the involved lower anterior teeth, pressing the 
tray as deeply as possible into position ; six or even eight teeth 
may be covered by the tray. The tray is now removed, and the 
modeling compound is cut away from the inner surface of the 



422 PHYSICAL THERAPEUTICS. 

cup, leaving only a thick continuous roll of compound covering 
the rim of the tray ; the tray is now connected with the syphon, or 
a strong syringe, or a pump, and the compound rim is slightly 
warmed and placed over the soft tissue, the latter being thoroughly 
dried and covered with a thick film of vaselin to facilitate the 
formation of an air-tight joint. A cup for the molars and bi- 
cuspids may be constructed on similar principles from the cut- 
off heels, and other suitable modifications which may be needed 
are left to the ingenuity of the operator. The suction must be of 
a mild degree, and is applied but once a day in short repetitions, 
as outlined above. 

In acute forms of empyema of the maxillary sinus, congestive 
hyperemia produced by suction or by the elastic bandage deserves 
to be recommended. In chronic cases it is of no benefit what- 
soever. 

Active Hyperemia. 

Pronounced active hyperemia is readily produced by dry hot 
air or by moist heat. The sources of heat may be manifold. Dry 
heat is readily obtained from a gas flame, coal oil lamp, electric 
heater or light globe, Japanese pocket stove, hot-water bag, etc., 
and moist heat from a hot wet pack or a poultice. Bier advises the 
use of hot air conveyed through a tube provided with a nozzle, 
which sprays, as it were, the heated air over the affected parts. 
He also advocates the use of hot-air boxes — boxes so shaped as to 
accommodate the diseased part of the body, to which the hot air 
is conveyed. The latter are rarely applicable to dental lesions. 



Therapeutic Applications. 

Acute and particularly chronic inflammation and their sequelae 
— adhesions, infiltrations, and exudations — are readily amenable 
to active hyperemic treatment. Of the specific diseases, neuralgia 
in its various forms is especially favorably influenced by heated 
air. The affected part is brushed over with the hot douche or 
with the therapeutic lamp for about ten minutes, and imme- 
diately after, or even during, the heat application is kneaded 



MASSAGE. 423 

and rubbed by massage movements. If the therapeutic lamp 
(see page 428) is used in this connection, no asbestos screen is 
necessary for the protection of the parts. 

MASSAGE. 

Massage (kneading or rubbing) is a therapeutic measure em- 
ployed for the purpose of treating diseases by mechanical move- 
ments. In medicine it is known by various terms — kinesitherapy 
(motion treatment), mechanotherapy, massotherapy, and, re- 
cently, osteopathy. Massage is one of the most ancient remedial 
agents, and in the form of medical gymnastics it has played an 
important part in the destiny of many nations. Its systematic 
employment has been equally lauded in bygone days by the 
physicians of Babylon, Alexandria, Athens, and Rome, and, while 
Europe of today enjoys a revival of massage under the name of 
Swedish movement, the United States, the "land of unlimited 
possibilities," has its modern apostle of the art of kneading in 
the person of Dr. Still, the founder of the osteopathic cult. Hip- 
pocrates, in his medical aphorisms, advises that "the physician 
ought to be acquainted with many things, and, among others, 
with friction." The therapeutic results of massage seemed to be 
fully appreciated by him, for he declares that "rubbing can bind 
a joint that is too loose, and can loosen a joint that is too rigid; 
that much rubbing causes parts to waste, while moderate rubbing 
makes them grow." The Chinese and Japanese are thoroughly 
familiar with muscle kneading, and the marvelous dexterity of 
the amma san, the blind Japanese masseur, excites the surprise 
and admiration of the western visitor. Even the aboriginal in- 
habitants of Africa and the South Sea islands practice massage in 
one form or another, and it is quite fashionable in Honolulu to 
be "lomi-lomied" after a hearty meal. Relative to this practice of 
massage, Nordhoff, in his description of the Sandwich Islands, 
makes the following statement: "Whenever you stop for lunch 
or for the night, if there are native people near, you will be greatly 
refreshed by the application of the lomi-lomi. Almost every- 
where you will find some one skilled in this peculiar and, to tired 
muscles, delightful and refreshing treatment. To be lomi-lomied, 



424 PHYSICAL THERAPEUTICS. 

you lie down upon a mat, or undress for the night. The less 
clothing you have on, the more perfectly the operation can be 
performed. To you thereupon comes a stout native with soft, 
fleshy hands, but a strong grip, and, beginning with your head 
and working down slowly over the whole body, seizes and squeezes 
with a quite peculiar art every tired muscle, working and knead- 
ing with indefatigable patience, until in half an hour, whereas 
you were weary and worn out, you find yourself fresh, all sore- 
ness and weariness absolutely and entirely gone, and mind and 
body soothed to a healthful and refreshing sleep. The lomi-lomi 
is used not only by natives, but among almost all the foreign 
residents; and not merely to procure relief from weariness con- 
sequent to overexertion, but to cure headaches, to relieve the 
aching, and neuralgic, and rheumatic pains, and by the luxurious 
as one of the pleasures of life." 

In 1780 Tissot reintroduced massage into France, and his and 
Meibom's (1795) writings helped much to popularize it among 
the masses. It was revived by Metzger, of Amsterdam, and his 
pupils in 1873. Henry Peter Ling, of Stockholm, worked out a 
system of mechanotherapeutics, which has become famous as 
the Swedish movement, or Lingism, and especially through Schrei- 
ber's manual on "Massage or Methodical Muscle Exercise" it 
has gained access to medical clinics of both continents. 

By massage we understand a series of mechanical movements 
best executed by the hands of the operator, affecting the skin as 
well as the deeper structures of the body. To employ it on a 
scientific basis, a fair knowledge of regional anatomy and physi- 
ology must necessarily be possessed by the operator. It is some- 
what difficult to describe minutely the various movements em- 
ployed in the art of massaging, and they are best acquired by 
personal instructions by a skilled operator. The object of massage 
is to bring about increased cell activity in the parts. Massage in- 
creases the flow of body juices — blood, lymph, chyle, etc. — in- 
creases secretion and excretion, and excites muscular activity. In 
general, its physiologic effects and therapeutic advantages are 
nearly identical with those obtained from any other source which 
is capable of producing artificial hyperemia. 



MASSAGE. 425 

The technique of massage may be divided into the following 
methods of application: Stroking, friction, kneading, percus- 
sion, and vibration, active and passive movements, or medical 
gymnastics. The movement of the hands in applying massage 
depends on the method employed. In stroking, the whole palm 
or the radial border of the hand, or the tips of the fingers, are 
used, the pressure being light in the beginning and gradually in- 
creasing to as much force as the case demands. The direction 
of the strokes in most cases is venous — centripetal, or toward 
the heart. Upon the head the movements are directed from the 
vertex downward. Friction is best applied by forcible, circular 
rubbing of the surface, starting at the border of the altered tis- 
sues and working toward the center from all directions. In 
kneading, squeezing, rolling, etc., the movements of pressure and 
relaxation are alternately and rhythmically employed to simulate 
natural muscular action, the object being to act upon the circula- 
tion of the deeper seated structures. The veins, capillaries, lymph 
vessels, and lymph spaces are emptied by pressure, the valves in 
the vessels preventing a return of the expelled fluids, but mak- 
ing room for a fresh influx. Percussion and vibration consist 
of a series of tapping, pounding, or beating movements very 
rapidly and rhythmically performed with the fingers, with the 
radial border of the hands, or by means of mechanical contriv- 
ances worked by the hand, a spring, or electricity, which causes 
muscular contraction. In the active, or Swedish, movement the 
patient concentrates his will on the muscle under treatment, caus- 
ing it to act, while the operator tries to resist the movement with 
slightly less force. After the muscle has fully contracted, the 
operator employs force, while the patient diminishes his resistance, 
until the muscle is brought back to its original position. In pas- 
sive massage all the movements of the muscles and joints are exe- 
cuted by the operator without resistance or assistance on the part 
of the patient. 

Medical gymnastics are principally employed for the purpose 
of exercising all those muscles which are seldom used, or which, 
for some special reason, require strengthening. 

From the view point of the dental therapeutist, massage is a 
serviceable adjunct to his armamentarium. It is indicated in all 



426 



PHYSICAL THERAPEUTICS. 



those conditions where a sluggish circulation in the soft tissues 
exists, and consequently all those diseases in which chronic in- 
flammation is an etiologic factor — gingivitis, pyor- 
rhea alveolaris, etc. — are directly amenable to this 
treatment. As a prophylactic measure, massage, in 
combination with the daily routine toilet of the 
mouth, deserves to be highly recommended. In the 
mouth proper the finger (bare or covered with a 
coarse linen finger cot or stall), the tooth brush 
(made of soft or coarse bristles, rubber, or woody 
fibers), or even some specially devised mechanical 
appliances, are used. Existing conditions and the 
individuality of the patient govern the methods and 
their application. The operator has to decide which 
grade and what kind of a tooth brush is best for the 
case in hand. Rotary movement and moderate pres- 
sure applied by a fairly coarse brush apparently pro- 
duce better results than a too soft or a too coarse 
brush used with heavy friction. The time required 
for oral massage is also dependent on conditions. On 
the average about five minutes three times daily are 
sufficient. For external facial massage, the finger 
tips or the electric vibrator are indicated. This also 
depends on conditions, the operator selecting the 
method best suited to his purpose. An electric den- 
tal vibrator has been devised and advocated by 
Mitchell. 1 It consists of a "cam-like piece of metal, 
perforated at its smaller end for mounting upon a 
screw mandrel, and is held in the dental hand 
piece strapped to the hand. Its centrifugal force 
imparts a vibratory motion to the hand, which 
can be utilized for massage with the finger tips, 
or by holding in the hand an instrument hav- 
ing on its end a soft rubber cup. The parts to be massaged 
should be lubricated with vaselin." Ointments are used 



Figure 59. 
Dental Vibrator. 2 



1 Mitchell: Dental Brief, 1908. 

2 An S. S. White engine mallet is provided with a soft or hard rubber cup, mounted on a suitable 
shank. Any desired degree of speed and force is readily obtained by the proper regulation of the 
mallet. 



LIGHT AND RADIO THERAPEUTICS. 427 

merely for the purpose of rendering the skin soft and pliable, 
and to enable the fingers to glide easily over the surface. No 
mechanical vibrators suitable for the oral cavity, so far as the 
author knows, are as yet to be found on the market. An instru- 
ment for the purpose may be readily constructed as follows: A 
suitable mandrel is provided with a threaded shank to fit the socket 
of an S. S. White engine mallet No. 4. The mandrel is bent to a 
slight obtuse angle, and mounted with a soft rubber tip, or Morri- 
son polisher; or a number of mounted cups and tips are kept on 
hand, and, when needed, securely fastened in a suitable porte 
polisher. Any desired degree of speed and force is readily ob- 
tained by the proper regulation of the mallet. It has been stated 
that a moose hide disk, mounted off the center and rotated in 
the dental engine, produces sufficient vibration for dental pur- 
poses. While this is true, the rapid rotation will incidentally 
produce a rubbing motion, which readily lacerates the gum tissue 
by brushing away its epithelial coating. The electric vibrator 
employed by professional masseurs should be used with caution 
on the face, as the author has seen a case where the too power- 
ful strokes of the instrument on the cheek of a lady almost 
completely knocked out a single standing lower molar. 



LIGHT AND RADIO THERAPEUTICS. 

W'ithin recent years light, in the form of sunlight or artificial 
light, has been freely discussed as a therapeutic agent of some im- 
portance. A comprehensive knowledge of light rays from the 
physicist's point of view is essential to a clearer understanding of 
their therapeutic action. The solar spectrum furnishes a band 
of colors consisting of violet, indigo, blue, green, yellow, orange, 
and red shades, which overlap each other. Beyond either end 
of the spectrum there are found a number of rays, the more im- 
portant ones being known as the infra-red and the ultra-violet 
rays. Certain rays possess specific functions. The infra-red rays 
are heat producers, and are spoken of as thermic or caloric rays; 
the yellow and green rays are predominant in the production of 
light, and are referred to as luminous rays, while the blue and 



428 



PHYSICAL THERAPEUTICS. 



violet rays, especially the ultra-violet rays, exercise a marked 
chemic influence on organic and inorganic matter, and are known 
as chemic or actinic rays. Concerning the therapeutic value of 
the various rays, it is known that the thermic rays produce active 
hyperemia, the actinic rays exercise a definite chemic influence 
on cell structure, and the luminous rays possess an analgesic 
effect. By specially constructed apparatus certain rays may be 
concentrated, others may be eliminated, and combinations of the 
rays in varying degrees may be produced at will. The various 
sources of light employed for therapeutic purposes are direct sun- 
light, the Finsen light, and the incandescent globe. For dental 
purposes, direct sunlight is probably rarely used. The Finsen 




Figure 60. 
Dental Electric Light. 



light, on account of its expense, is largely confined to special 
sanatoria, while the incandescent globe, on account of its sim- 
plicity, deserves to be recommended. 

The Finsen lamp produces an intense, cold light; it is especially 
rich in ultra-violet rays, while the thermic rays have been largely 
excluded. The chemic influence of the Finsen light manifests 
itself principally in the destruction of the pus-producing elements, 
without, however, unfavorably influencing cell proliferation. Its 
essentially preservative action results in the formation of white, 
smooth scars, without contraction of the tissues. The Finsen 
light is much lauded for the treatment of lupus and similar dis- 
eases of the skin and mucous membranes. As stated above, the 



LIGHT AND RADIO THERAPEUTICS. 



429 



therapeutic action of the mixed light rays is destructive to micro- 
organisms; the rays act as analgesics, and they produce intense 
active hyperemia, with all its sequences. We possess, however, at 
present so very little definite knowledge concerning their action 
on living tissue that positive statements regarding their therapeutic 
indications should be regarded only as possibilities based largely 
on empiricism. 

The electric light best suited for dental purposes is a one-hun- 
dred-candle power incandescent globe, having a hard carbon fila- 
ment, and inclosed in a suitable projector. Much confusion ex- 
ists regarding the relative therapeutic value of lamps of different 
candle power. It should be borne in mind that a one-hundred- 




FlGURE 61. 

Dobrzyniecki's Heat and Light Reflector, a, lens; b, lens; c, lens; d, flame; e, mirror. 



candle power lamp is just as efficient, therapeutically speaking, as 
a five-hundred-candle power light. The patient can bear only 
a certain amount of heat, and any more heat produced by the 
lamp is wasted. A one-hundred-candle power lamp furnishes 
sufficient caloric rays to readily burn tissue. The projector should 
be of the parabolic type — that is, so constructed as to furnish 
parallel rays only. It is claimed that the metal best suited for a 
reflector is an alloy of aluminum and manganese. To modify 
or intensify the various rays of this lamp, yellow, blue, or amber 
colored glass screens may be clamped to the projector. A free 
current of air should circulate through the reflector, as this will 



430 



PHYSICAL THERAPEUTICS. 



insure a bright light and prevent ready blistering of the patient. 
In using a high power lamp, a quick-acting switch is necessary, 
as all other forms of cut-offs readily burn out. * If electricity is 
not available, a common coal oil lamp, with a one-half-inch round 
burner, provided with a reflector, answers the purpose fairly well. 
A simple and efficient reflector may be constructed, according to 
Dobrzyniecki, 1 as follows: A three-inch convex mirror reflects 
the rays through a plano-concave lens two inches in diameter; 




Figure 62. 

Mode of Application of the Therapeutic Lamp. The therapeutic portable lamp is guided 
by the operator. The patient protects himself with an asbestos screen, which has a hole cut 
near the center to allow the rays to pass through. 



the longer end of the cone-shaped connecting tube, being about 
ten inches long, is provided at its largest diameter with a three- 
inch double convex lens; the small end of the tube measures 
about four inches, and has a two-inch double convex lens near 
the outlet. The rays are reflected by the mirror and pass through 
the series of lenses, the last one being brought in close contact 
with the patient. 



1 Dobrzyniecki: Wiener Zahnarztliche Monatsschrift, 1903, p. 287. 



HEAT AND COLD. 431 

Therapeutic Applications. 

In the practice of dentistry the mixed rays of light obtained 
from what is technically known as a one-hundred-candle power 
therapeutic lamp are usually employed. In the mouth proper 
only the anterior teeth and gum tissue are directly amenable 
to this treatment. To expose the parts as much as possible, a 
mouth speculum is inserted, and the patient's face is protected by 
an asbestos screen, with an opening cut in the center about two 
inches long and one-half inch wide, which is held by the patient 
about two inches in front of the parts to be treated. The lamp 
is held in front of the screen, the distance depending on the degree 
of heat produced. The light is used with a brushing motion, and 
should not be focused too persistently on any one point. On the 
face it is used in practically the same manner. A thin coat of 
vaselin spread over the surface to be treated relieves undue ten- 
sion. To receive the full benefit of the light treatment, the part 
to be treated should be continuously exposed twice at one sitting 
for about fifteen minutes each time, with an interval of half an 
hour, and preferably immediately followed by massage. 



HEAT AND COLD. 

Heat and cold are frequently referred to as distinct entities, but 
in reality they are merely relative terms, expressing the variations 
above and below normal temperature. By the latter term the 
temperature of the human body— about 98.4° F. (36.9° C.) — 
is meant, and is taken as the average caloric indicator. 

Heat is applied in two forms — dry heat and wet, or moist, heat. 
The physiologic effect of both is the same, and they produce a 
pronounced active hyperemia, with all its phenomena. Dry heat 
can be borne by the body at a very much higher degree than 
moist heat, In the Turkish bath temperatures as high as 140 
to 150° F. (60 to 66° C.) are frequently reached, while moist 
heat in the form of a poultice should be limited to 105 to 110° 
F. (40 to 43° C). Above this temperature moist heat is inju- 
rious to the soft tissues. The body protects itself against great 



432 PHYSICAL THERAPEUTICS. 

heat by the free evaporation of profuse perspiration and the 
powerfully accelerated blood stream within the heated area. Dry 
heat is conveyed to the tissues through the air, and, as air is a 
very poor conductor, much of the heat is lost; while moist heat 
is kept in intimate contact with the tissues, and is held there for 
a definite period. The continuous application of heat on patho- 
logically altered tissues produces definite changes in the structures. 
The resulting increased osmotic pressure exerts a powerful in- 
fluence on the centrifugal flow of the lymph, and the products of 
the early stages of inflammation are carried away from the center 
toward the periphery, to be poured into the circulating blood 
stream or otherwise disposed of. If pus is about to gather, the 
heat will materially assist in the ready breaking down of the 
affected structures, and will help to "ripen" the abscess. 

The general effects of cold on the tissues manifest themselves 
in lowering the temperature, diminishing the sensibility, and 
contracting tissues and vessels, thereby reducing the volume of 
these parts. Cold continuously applied benumbs the part, and pro- 
duces in due time a definite local anesthesia. Cold, when locally 
and continuously applied in the form of an ice pack, cold water 
coil, towels wrung out in iced water, etc., causes a temporary 
inhibition of inflammation in its very early stages. Its anti- 
phlogistic action is manifested by retarding circulation and in- 
hibiting the emigration of the leucocytes. As soon as the cold 
application is removed, the inflammatory process starts with re- 
newed activity. When applied to an infiltrated area, it produces 
anemia and increases the osmotic pressure within the edematous 
field surrounding the focus of inflammation, which results in 
severe pain and, under certain conditions, in distinctly dangerous 
symptoms — as, for instance, in passive hyperemia or stasis of 
the pharynx. 

Therapeutic Applications. 

Heat and cold are applied for general purposes in the many 
varieties of the bath, while locally any neutral material which 
will convey and retain either one for a sufficient length of time 
may be used. Apparently there exists quite a diversity of opinion 



HEAT AND COLD. 433 

relative to the use of moist heat, dry heat, and cold. Both forms 
of heat, locally applied, are productive of the same results. They 
induce intense active hyperemia, and apparently it makes little 
difference what form of heat is employed. The choice between 
heat and cold, in general conditions, is largely governed by the 
wish of the patient, except in fever, and the patient will usually 
assert that one of the two is more agreeable to him. If we are 
dealing with a pericemental inflammation and the consequential 
formation of an alveolar abscess, the conditions for the require- 
ment of heat and cold can be more definitely outlined. Clinical 
experience has taught that in the early stages of pericemental in- 
flammation ice chips held in the mouth are useful in retarding 
the process of inflammation and mitigating the pain. If the in- 
filtration of the tissues has proceeded to such an extent as to 
indicate possible pus formation, a hot poultice placed directly over 
the offending tooth and covering the entire inflamed area, applied 
in the oral cavity, is extremely serviceable. 

Poultices (cataplasma, L. ; cataplasme, F. ; Breiumschlag, G.) 
are soft, moist applications, usually employed hot, but sometimes 
cold; and occasionally they may contain drugs indicated to exert 
some specific action. Poultices furnish more or less constant 
heat and moisture, and thereby relax the skin, thus favoring 
swelling, but lessening tension of the tissues. Whenever a hot 
poultice is employed, it should always cover the field of inflam- 
mation in its entirety, or it may be applied in the form of a 
broad ring. It should never be so small as to cover the center 
of inflammation only, as then the pain is certain to increase. A 
hot poultice has no place on an opened or a septic wound, as it 
would practically seal up the infected focus, and the pent up 
infection would rapidly involve the surrounding tissues. 

A hot poultice placed externally on the cheek in pericemental 
infiltration is always dangerous, as it will assist in drawing the 
pus to the surface, which means an external opening, with the 
possibility of a disfiguring scar. A serviceable poultice to be 
applied over a tooth, and one which will retain heat for a suf- 
ficient time, is preferably applied in the form of raisins or figs 
cut into slices and boiled in water. These slices should be ap- 



434 PHYSICAL THERAPEUTICS. 

plied as hot as can be borne, and renewed as often as necessity 
demands. 

For the application of dry heat on external body surfaces many 
forms of heat carriers are employed. The heated brick, hot-water 
bottle, heated salt bags, the Japanese stove, and many other means 
are utilized to retain heat for a limited time. A permanent source 




Figure 63. 
Electric Thermaphone Pad. 

of heat is obtained by wrapping an electric light globe in suitable 
material (cotton), and placing it against the diseased part. To 
avoid the danger of breaking the globe, an electric heating pad, 
known as a thermaphone, has recently been placed on the market, 
which, from all appearances, seems to serve its purpose well. 

Within recent years the introduction of the so-called clay poul- 
tices, under various fanciful names, have been much discussed 
in current literature. From the ludicrous advertisements of the 
makers of the various clay poultices the practitioner may be 
placed under the impression that this new panacea is far superior 
to any other form of poultice. One preparation carries the fol- 
lowing teleologically constructed explanation regarding its action : 

"The skin may be regarded as a permeable membrane separating 
two fluids of different densities — the blood and the clay poultice. 
If the * * * (clay poultice) is applied hot under such con- 
ditions, something definite happens, and that scientifically — an 
interchange of fluids, most marked toward the clay poultice ; hence 
the deduction that the mixture acts through reflex action and 
dialysis, the latter scientifically including the physical processes 
of exosmosis and endosmosis, and that the blood pressure from the 



PLUGGING BONE CAVITIES. 435 

overworked part is reduced, the muscular and nerve resistances 
are relaxed, and refreshing sleep is invited." 

Roth 1 and, very recently, Pilchen 2 have experimentally dem- 
onstrated that an old-fashioned flaxseed poultice holds the heat 
markedly longer than its modern substitute, and that, "further- 
more, one is immediately convinced that no process of osmosis or 
endosmosis is involved, for the much simpler explanation suffices 
that the gain of weight is due to the absorption by the clay poul- 
tice of the increased local perspiration, which latter in turn is due 
to the local application of continuous heat. Indeed, the pre- 
vailing scientific opinion is that nothing passes from within 
outward through the intact skin except by way of the sweat 
glands." 



PLUGGING BONE CAVITIES WITH INERT OR 
MEDICATED SUBSTANCES. 

The filling of cavities caused by the destruction of bone with 
inert or medicated substances is materially simplified by employ- 
ing the ingenious methods outlined by the late Mosetig-Moorhof. 
Mosetig 3 divides the substances that are used for this purpose into 
absorbable and nonabsorbable materials. The absorbable ma- 
terials are again divided into autoplastic and heteroplastic sub- 
stances. The filling of bone cavities by the Mosetig process is 
accomplished by using only heteroplastic substances. In the 
practice of general surgery, bone filling by divers materials is 
utilized to quite an extent, and the Mace wen operation, Senn's 
bone grafting, etc., are examples of such procedures. Mosetig ad- 
vised the use of a solid, but readily absorbable, material which can 
be easily introduced into the "dead spaces" in a liquid form, so 
as to fill all the nidi and crevices that are liable to remain after 
a bone operation or after bone absorption. The material advo- 
cated by Mosetig consists of a mixture of iodoform, spermaceti, 
and oil of sesame, and is known in general surgery as "bone 



1 Roth: Journal A. M. A., April 15, 1905, p. 1185. 

2 Pilchen: Journal A. M. A., March 6, 1909, p. 752. 

3 Mosetig-Moorhof: Wiener Klinische Wochenschrift, 1906, No. 44. 



436 PHYSICAL THERAPEUTICS. 

plombe." 1 Mayrhofer 2 recognized the value of the Mosetig bone 
plombe in its relation to dental surgery, and he advocated its use 
in a modified form in 1905. The dental indications for this pro- 
cedure are manifold. It is especially serviceable after root ampu- 
tations, in abscess cavities with or without fistulas, in bone cavities 
resulting from the various causes of necrosis, in the treatment of 
pyorrhea alveolaris, to some extent in the treatment of chronic 
empyema of the antrum, etc. In applying this method of treat- 
ment a few salient factors are essential, and their strict recogni- 
tion is of the utmost importance for the success of the treatment. 
The cavity which is to be filled with the bone plombe must be 
absolutely dry. This can be readily accomplished by packing the 
cavity with strips of gauze, which are removed at the very moment 
the liquid plombe is put in place. The hot air blast is often of 
great assistance for such work. The plombe must completely 
fill the cavity — that is, it must not contain air spaces. By press- 
ing the semisolid material into place with tampons of gauze, and 
by using a heated pointed instrument, a solid filling is readily 
obtained. The filling in the bone cavity after a root amputa- 
tion, etc., should be covered with the primarily lifted up muco- 
periosteum, while in the case of fistulas no further protection is 
necessary. Mayrhofer advocates holding the periosteal flap in 
position by a suture. We have never had occasion to use a suture 
for this purpose. After the flap is replaced, the lip or cheek 
exercise sufficient pressure to hold it in correct position. In 
1901 Bohm 3 constructed a small syringe with which it is possible 
to deposit the medicated bone plombe in the form of a bougie 
in an even manner in any crevice or corner which can not be 
reached otherwise. This little syringe is supplied with a number 
of cannulas of various shapes, and is especially of service in 
the treatment of chronic alveolar abscesses. This little device has 



1 Plombe is the German term for the filling of a tooth, and Plombierung indicates the process 
of filling teeth. Plombe is derived from plumbum, the Latin term for lead, a material which at 
one time was in general use for stopping cavities in teeth. The term bone plombe has been 
generally accepted by American and English writers as a special, descriptive term for the 
Mosetig process of filling the dead spaces after bone operations. 

2 Mayrhofer: Osterreich-Ungarische Vierteljahrsschrift f iir Zahnheilkunde, 1905, No. 2; 
1906, No. 3; 1907, No. 1. 

3 Bohm: Zahnarztliche Rundschau, 1901, No. 451. 



PLUGGING BONE CAVITIES. 



437 



been successfully employed for such work by Bohm, Misch 1 , Lies, 2 
and others.. 

The technique of placing the ploinbe is simple. In the early 
days of the operation, Mayrhofer used a hot water jacket syringe, 
but at present he relies upon a wax spatula and a few T pointed in- 
struments. Beck advises an all-metal syringe or a collapsible 
tube, fitted with a flexible cannula having a fine, tapering point 
mads of pure silver. In all cavities that afford ready access an 
ordinary wax spoon, a pointed metallic instrument, and a few 
gauze tampons answer the purpose sufficiently well. For cavities 




Figure 64. 
Bohm's Syringe for Bone Plombe. 



having no direct access, a syringe with a curved cannula, or a 
collapsible tube with a flexible cannula, is necessary. For the 
filling of ve*ry narrow cavities — fistulous tracts, pockets of pyor- 
rhea alveolaris, etc. — the Bohm syringe is very serviceable. The 
syringe is applied with various bent cannulas, which readily reach 
any part of the mouth. For the treatment of an abscess, a small 
amount of the slightly warmed, but not liquefied, paste is rolled 
into a cylinder (a bougie), which is inserted into the Bohm 
syringe supplied with the proper cannula, and a slight pressure 
is asserted upon the piston until the paste appears at the point 



1 Misch: Osterreichische Zeitschrift fur Stomatologic, 1904, No. 4. 
- Lies: Deutsche Zahnarztliche Wochenschrift, 1903, No. 4. 



438 



PHYSICAL THERAPEUTICS. 



of the cannula. A small piece of rubber tubing or temporary 
stopping is now placed about the tip of the cannula. to form an 
air-tight joint, and the syringe is tightly inserted into the root 
canal. Slight, but continuous, pressure is now applied to the 




Figure 65. 

Collapsible Tube for Bone Plombe. A flexible cannula attached to a collapsible tube for 
placing the bone plombe. 

piston until the bone filling appears at the mouth of the fistula. 
The canal is sealed with temporary stopping. If necessary, the 
treatment is repeated in a few days. 

The bone filling consists of an unctuous base, to which some 



PLUGGING BONE CAVITIES. 



439 



strong antiseptic has been added. The original Mosetig bone 
plombe was prepared by melting together equal parts of oil of 
sesame (oil of benne) and spermaceti, filtering and sterilizing 





A Hypodermic Syringe Prepared for Bone Plombe. A flexible cannula is attached to the 
hypodermic syringe for the purpose of conveying the bone plombe to a root canal of a tooth. 

the liquid in a water bath, and then pouring 60 grams of the 
hot mixture into a farge dry bottle containing 40 grams of finely 
pulverized iodoform, and shaking constantly until the mass 



440 PHYSICAL THERAPEUTICS. 

hardens. For dental purposes, Mayrhofer advises the follow- 
ing modified formula : 

Spermaceti 30 parts. 

Oil of sesame 15 parts. 

Iodoform 10 parts. 

This combination produces a more durable filling, as it is of a 
harder consistency than the original formula. The iodoform odor 
is extremely disagreeable, and even nauseating, to some patients. 
By substituting an odorless iodin compound — as europhen, vio- 




FlGURE 67. 

Bone Plombe in Position. An x-ray picture of a fistula filled with bone plombe leading from 
a lower incisor through the body of the mandible to the chin. 



form, aristol, etc. — this objection is readily overcome without 
materially lessening the antiseptic qualities of the filling. The 
ready-made filling is kept in small well-stoppered bottles, test 
tubes, or collapsible tubes. By placing the bottle or tube in a 
container filled with hot water, it is heated to the point of liquefac- 
tion, stirred, and is then ready for use. 

Recently Rudolph Beck 1 has described a similar filling which 



1 Rudolph Beck: Dental Review, 1909, No. 1. 



PLUGGING BONE CAVITIES. 441 

was suggested to him by Emil and Joseph Beck. The latter em- 
ploy this paste in sinuses of joints and abscess cavities. The 
Beck bone paste is composed as follows: 

Bismuth subnitrate 30 parts. 

White wax 5 parts. 

Paraffin 5 parts. 

Vaselin • 60 parts. 

The ingredients are mixed by boiling. 

The technique of applying the Beck paste is similar to Mayr- 
hofer's method. Rudolph Beck and, recently, Warner 1 speak 
very highly of its value in dental surgery. Rudolph Beck recom- 
mends this paste especially as a means of treating pyorrhea alveo- 
laris. He injects the liquid paste with gentle, but steady, pres- 
sure into the pus pockets about the teeth, so as to reach the 
very bottom of every crevice. There are certain objections to 
the Beck paste which render it of little value compared with 
Mayrhofer's modification of the Mosetig plombe. As stated above, 
the unctuous portion of the paste consists almost wholly of 
paraffin and vaselin. These substances are hydrocarbons, and 
are not absorbed by the tissues. For this very fact they are 
largely employed for the restoration of collapsed tissues in cos- 
metic surgery — the saddle nose, etc. The object of the Mosetig 
treatment in dental surgery, as outlined above, requires absorb- 
able material, and therefore animal or vegetable fats and oils 
must be used. Furthermore, bismuth subnitrate produces serious 
intoxications through absorption when injected in large quantities 
into the tissues or when used upon wound surfaces, causing 
stomatitis and ulceration of the mouth, necrosis, and even death. 
A distinct deep blue line on the gums, similar to the lead line pro- 
duced by chronic lead poisoning, is left as a more or less perma- 
nent result of bismuth poisoning. Two cases of bismuth poison- 
ing following the injection of Beck's paste are recently recorded. 2 
The first patient received eight ounces of a SoVs-percent bismuth 
paste and later six ounces of the same material. It was followed 
by the typical bismuth stomatitis, etc. The patient made an 

1 Warner: Dental Brief, 1909, No. 5. 

2 David and Kauffman: Journal A. M. A., 1909, Vol. LII, p. 1055. 



442 



PHYSICAL THERAPEUTICS. 



uneventful recovery. In the second case the patient received 
six ounces of the paste and died within twenty-seven days after 
the injection from bismuth poisoning. While it is probably true 
that such doses are rarely required for dental purposes, it should 
be remembered that absorption from the oral tissues is accom- 
plished much more readily than from most other tissues, and 
consequently bismuth intoxications may be more readily antici- 
pated from the absorption of less quantities from the oral cavity 
than from other parts of the body. The iodin preparations — 




Figure 68. 
A Large Cavity in the Mandible Filled with Bone Plombe. 



iodoform, vioform, aristol, etc. — possess decided advantages over 
bismuth subnitrate as bactericidal or chemotactic agents. In ah 
extensive necrosis of the mandible the author has injected 
recently about l 1 / 3 ounces (40 (mi.) of Mayrhofer's iodoform 
paste, the largest quantity ever used by him for a single operation. 
There were no systemic effects produced by the slow absorption 
of the paste, and within four months the destroyed tissues were 
partially replaced by a new formation of a heavy periosteum. 

The plugging of bone cavities with the Mosetig bone plombe 
according to Mayrhofer's modification deserves to be recommended. 



PART IV. 
LOCAL ANESTHESIA. 



HISTORY. 1 

The elimination of pain during surgical operations is insepa- 
rably interwoven with the history of the human race. It has 
always been the aim of those interested in the cure of bodily ills 
to relieve pain in some empirical manner. The efforts to solve 
the riddle of painless operations were, however, seemingly so very 
futile that even as late as 1832 Velpeau was led to express his 
pessimism as follows: "To escape pain in surgical operations is a 
chimera, which we are not permitted to look for in our time." 
Little did he expect that he stood at the very threshold of the 
discovery of anesthesia, and that less than a decade later the 
''nirvana' 7 of painless operations would be an accomplished fact. 
And when Dieffenbach in 1847 wrote those classical words re- 
garding the use of ether as an anesthetic, ''the beautiful dream, 
to eliminate pain, has become a fact — pain, the highest conscious- 
ness of our earthly existence, its clearest conception of the im- 
perfections of our body, it has to bow low before the powers of 
the human mind," the world at large awakened to the fact that 
pain had been conquered. 

The discovery of anesthesia is essentially to be credited to the 
dental and medical profession of the United States, and the names 
of Crawford W. Long, Horace AVells, AVilliam P. G. Morton, and 
Charles F. Jackson are inseparably connected with it. "If 



1 The amount of literature on local anesthesia and anesthetics is enormous, and would fill a 
large volume. To mention merely a few of the more important investigators who have con- 
tributed some notable additions to this most interesting chapter in pharmacc-therapeutics, the 
following names, including the year of their publication, may suffice: Waddel, 1853; Gardeke, 
1855; Niemann, 1860; Van Anrep, 1879; Konigstein, 1884; Roller, 1884; Corning, 1885-6; Witzel, 
1886; Viau, 1886-1904; Mosso, 1887; Wolffer, Franckel, Chiari, etc., 1887; Braun, 1887-1909; Reclus, 
1889-1903; Schleich, 1901-6; Crile, 1902; Carpenter, 1902; Davis, 1903; Tuller, 1903; De Vries, 1904; 
Johnson, 1904; Loeffier, 1904; Fischer, 1903; Cieszynski, 1903; Euler, 1907; Liebl. 1906. 

443 



444 LOCAL ANESTHESIA. 

America has contributed nothing more to the stock of human 
happiness than anesthetics, the world would owe her an everlasting 
debt of gratitude," said the late Samuel D. Gross, the eminent 
surgeon, who had ample opportunity to observe in his own 
operating room the most remarkable changes that followed the 
introduction of anesthetics. 

From an historical view point, comparatively few important 
methods for the purpose of locally obtunding pain are to be 
recorded prior to the introduction of cocain. The compression of 
nerve trunks for the abolition of pain seems to be of an old and 
unknown origin, which was revived by Guy du Chauliac and 
Ambroise Pare, and finally found a permanent place in surgery 
as the Esmarch elastic bandage. Physically reducing the tem- 
perature of a part of the body by the application of cold was 
instituted much later. Bartholin and Severino introduced this 
method in the middle of the sixteenth century. It became a 
lost art, however, until John Hunter, of London, again called 
attention to its benefits by demonstrating it upon animals; and 
Larray, the chief surgeon of Napoleon's army, employed it for 
amputating purposes (1807). James Arnott, in 1849, utilized 
a freezing mixture, consisting of ice and salt, as a means of 
producing local anesthesia. Through the efforts of Sir B. W. 
Richardson, in 1866, it was placed on a rational basis by the 
introduction of the ether spray. The various narcotics which 
were employed for internal purposes were also made use of as 
local applications. Mandragora, henbane, aconite, the juice 
of the poppy head, and many other analgesic drugs enjoyed a 
world-wide reputation. There is probably no other medicinal 
plant around which clusters more mysterious and quaint associa- 
tion than mandragora. It should be remembered, however, that 
mandrake, or mandragora (atropa mandagora) , must not be con- 
founded with American mandrake, or may apple {podophyllum 
peltatum) , to which it bears no relation. 

Probably the oldest known dental prescription that was used 
for the purpose of abolishing pain arising from an aching tooth 
is recorded upon a clay tablet that was found in Niffer, and its age 
may be approximately placed at 2250 B. C. Recent excavations 



HISTORY. 445 

that have been made near Niffer and Babylon have brought to 
light valuable information regarding the practice of medicine 
under Hammurabi, king of Babylon, a contemporary of Abraham. 
The clay tablet is written in the Babylonian tongue, which was 
the official language of diplomatic intercourse from the Euphrates 
to the Nile. The contents of this tablet refer to the "worm" 
theory of dental caries, and the treatment consists in filling the 
painful cavity of the tooth with a cement prepared by mixing 
powdered henbane seed with gum mastic. While filling the 
"upper part of the tooth" suitable incantations were recited. It 
is interesting to observe that the physiologic conception of this 
text is humoral (hematic), and that the health of the teeth is 
dependent upon the circulation within the tooth substance. 1 In 
Egypt the suet of the crocodile, locally applied, was believed to 
relieve pain, and Pliny refers casually to the mystic Lapis Mem- 
phitisj the stone of Memphis, which, when rubbed on the surface 
of the skin in conjunction with sour wine, was said to produce local 
anesthetic effects. Nepenthe, a preparation of purified opium, 
was much praised by the Greeks. Alcohol, in its various forms, 
always enjoyed a wide reputation as a pain reliever, and seems 
to be as old as the world's history. In an early Cymric manu- 
script, said to have been compiled by Howell, the physician, who 
was the' son of Rhyr and a lineal descendant of Einion, and 
which was probably written about the end of the fifteenth 
century, among a large number of conjectures we find the follow- 
ing: "How to extract a tooth without pain: Take some newts, 
by some called lizards, and those nasty beetles which are found 
in ferns in the summer time. Calcine them in an iron pot, and 
make a powder thereof. Wet the forefinger of the right hand, 
and insert it in the powder, and apply it to the tooth frequently, 
refraining from spitting it off, when the tooth will fall away 
without pain. It is proven." 2 During the middle ages the fol- 
lowing mixture, as recorded by Cardow, was frequently used as a 
local anodyne in the form of an ointment : "Opium, celandine, 
saffron, marrow and fat of man, together with oil of lizards." 



1 Von Oeffele: Mitteilungen zur Geschichte der Medizin, etc., 1904. 

2 Hermann Peters: Der Arzt und die Heilkunst, 1900. 



446 LOCAL ANESTHESIA. 

The "Kra uter Biicher" (books on vegetable remedies) of the six- 
teenth and seventeenth centuries contain innumerable compounds 
which are recommended as specific dental remedies. 

The empirical search for new methods and means pressed the 
mysticism of the electric current into service, opening a prolific 
field to the charlatan, which even to this day has not lost its 
charm. Richardson's voltaic narcotism for a time attracted the 
attention of the medical and dental profession. Its inventor 
claimed "that by the action of a galvanic current, passing through 
a narcotic solution, held in contact with the part to 'be operated 
upon, some of the narcotic substance passed much more rapidly 
into the tissue, and that in many instances complete local anes- 
thesia was in this way produced by solutions which are entirely 
inert when applied, even to the most delicate tissue, without the 
galvanic current." This very same principle, discovered by 
Reuss in 1807, and introduced by him as "electric endosmosis," 
or as "cataphoresis" by E. du Bois-Raymond, was "newly discov- 
ered" and reintroduced into dentistry about a decade ago. In 
cyclonic fashion it swept over the globe, but today it is almost 
forgotten. Electric or galvanic anesthesia was suggested as far 
back as 1851 by Dr. A. Hill, 1 of Connecticut. Francis, 2 in 1858, 
recommended the attachment of the electric current to the well- 
insulated handles of the forceps for the painless extraction of 
the teeth, and, as dental depots still offer appliances of this na- 
ture for sale, it seems that this method is still in vogue with 
some operators. According to Regner and Didsbury, as cited by 
Sauvez, 3 a current of electricity of high frequency, when directed 
toward the long axis of a tooth for a shorter or longer period 
previous to its extraction, produces insensibility to pain. In 1880 
Bonwill 4 suggested his method of "rapid breathing as a pain ob- 
tunder," which he claimed "produces a similar effect to that of 
ether, chloroform, and nitrous oxid gas in their primary stages." 
In the early days of modern dentistry many feeble efforts were 
made to alleviate pain during trying operations. Chloroform, 
alcohol ether, aconite, opium, the essential oils, and many other 



1 Hill: New York Dental Record, Vol. VI, p. 145. 

2 Francis: American Journal of Dental Science, 2d Series, Vol. VIII, p. 433. 

3 Sauvez: A Study of the Best Means of Local Anesthesia, Paris, 1904. 

4 Bonwill: American System of Dentistry, Vol. Ill, p. 213. 



MEANS OF PRODUCING LOCAL ANESTHESIA. 447 

drugs were the usual means that were employed, either separately 
or as compounds, usually under fanciful names, for such pur- 
poses. Snape's calorific fluid, composed of chloroform, tincture 
of lemon balm, and oil of cloves; nabolis, consisting of a gly- 
cerite of tannic acid and a small quantity of chloral hydrate ; Mor- 
ton's letheon, which was sulphuric ether mixed with aromatic 
oils, are examples of proprietary preparations which enjoyed quite 
a reputation in their time. 1 In 1853 Alexander Wood introduced 
a method of general medication by means of hypodermic injec- 
tions, and a few years later the French surgeon Pravaz modified 
the old style syringe for this special purpose, which since is 
known as the "Pravaz" or hypodermic syringe. At once it was 
suggested to apply such drugs as morphin or tincture of opium 
for the purpose of producing local anesthesia. The results were 
not encouraging, however, until cocain was advocated. Cocain 
was discovered by Niemann in 1859, but it required twenty-five 
years to make known the remarkable anesthetic properties which 
this alkaloid possessed when applied in the ready soluble 
form of its hydrochloric salt. It was on September 15, 1884, 
that Carl Koller, 2 of Vienna, presented his epoch-making com- 
munication at the Ophthalmologic Congress at Heidelberg, in 
which he demonstrated the effects of cocain as a local anesthetic. 
With the introduction of this drug into therapeutics, local anes- 
thesia achieved results which were beyond expectations, and its 
final adoption created a new era in local anesthesia. 

MEANS OF PRODUCING LOCAL ANESTHESIA. 

The term anesthesia (without sensation), which was suggested 
in 1846 by that great physician-litterateur, Oliver Wendell 
Holmes, to Dr. Morton, is usually defined as an artificial depriva- 
tion of all sense of sensation, while the mere absence of pain is 
referred to as analgesia. Correctly speaking, the term local anes- 
thesia is partially a misnomer. In producing local anesthesia we 
do not fully comply with all the requirements that anesthesia 



1 Flagg-Foulks: Dental Pathology, etc., 1885, p. 110. 

2 Roller: 16th Ophthalmologenkongress, Heidelberg, 1884. 



448 LOCAL ANESTHESIA. 

demands, because a part of the sensorium — the sense of touch, 
for instance — is not abolished. The term local anesthesia has, 
however, acquired such universal recognition that it would seem 
unwise to recommend a change. 

Anesthesia may be artificially produced by inhibiting the sen- 
sory nerve fibers at their central end-organs in the brain or at 
their peripheral end-organs in the tissues, thus producing general 
and local anesthesia. Local anesthesia may be obtained in two defi- 
nite ways. We may inhibit the function of the peripheral nerves 
in a circumscribed area of tissue, and we refer to this process 
as "terminal anesthesia," while, if we block the conductivity 
of a sensory nerve trunk somewhere between the brain and the 
periphery, we speak of it as "conductive anesthesia." Conductive 
anesthesia may be produced by injecting into the nerve trunk 
proper — endoneural injection — or by injecting into the tissues 
surrounding a nerve trunk — perineural injection. The latter 
form is the usual method pursued when conductive anesthesia for 
dental purposes is indicated. 

The successful practice of local anesthesia involves the care- 
fully adjusted co-operation of a number of important details, each 
one constituting a definite factor in itself, which, when neglected, 
must necessarily result in failure. As a whole, the practice of 
local anesthesia by the hypodermic method represents the com- 
posite of the following factors: 

1. A solution of active ingredients corresponding to the phys- 
ical and physiologic laws which govern certain functions of the 
living cell. 

2. A carefully selected hypodermic armamentarium. 

3. A complete mastery of the technique. 

4. A proper selection of the correct method suitable for the 
case on hand. 

5. Good judgment of prevailing conditions. 

PHYSIOLOGIC ACTION OF ANESTHETICS. 

According to more recent therapeutic conceptions, it is gen- 
erally recognized that a drug or combination of drugs which sim- 



PHYSIOLOGIC ACTION OF ANESTHETICS. 



449 



ultaneously produce local anemia and inhibition of the sensory 
nerves in a circumscribed area of tissue is the logic solution of 
the question of local anesthesia. Certain important factors, how- 
ever, relative to the physiologic and physical action of the solu- 
tion employed for hypodermic injection upon the cell govern the 
successful application of such methods. It is of prime impor- 
tance, therefore, to comply with the laws regulating the absorp- 
tion of injected solutions — osmotic pressure. 

If we separate two solutions of salt of different concentration 
by a permeable animal membrane, a continuous current of salt 




Figure 69. 



Plasmolysis of Cells of Tradescantia Diseolor. 
plasmolysis; c, pronounced plasmolysis. 



(Hugo de Vries.) a, normal cell; b, beginning 



and water results, which ceases only after equalization of the 
density of the two liquids — that is, equal osmotic pressure (ac- 
cording to the Boyle- Van't Hoff law) is established. The current 
passes in both directions, drawing salt from the stronger to the 
weaker solution, and water vice versa, until osmotic equilibrium 
is obtained. The resultant solutions are termed, according to 
De Vries, 1 isotonic. The latter studied these conditions carefully 
with plants, especially with the leaves of tradescantia discolor. 
If the leaves of this plant are placed in a fairly concentrated 
salt solution, water is removed from the cells until the osmotic 



1 De Vries: Wissenschaftliche Botanik ( Jahrbiicher) , 1884. 



450 LOCAL ANESTHESIA. 

pressure of the cell contents and the surrounding fluid are equal- 
ized. The volume of the cell is reduced, the cell protoplasm 
draws away from the cell wall, usually starting in the corners, 
until it is attached only by a few strands to the framework. This 
process is called by De Vries plasmolysis. 

Osmotic pressure is a physical phenomenon possessed by 
water and all aqueous solutions, and is dependent on the number 
of molecules of salt present in the solution and on their power of 
dissociation. In organized nature these osmotic interchanges play 
an important factor in regulating the tissue fluids of both ani- 
mals and plants. The life of the cell depends on the continuous 
passage of these tissue fluids, which furnish the nutrient mate- 
rials, consisting of water, salt, and albumin. These chemicals are 
normally present in certain definite proportions. The membrane 
of the living cell is, however, only semi-permeable — that is, the 
cell readily absorbs distilled water when surrounded by it. The 
cell becomes macerated, loses its normal structure, and finally 
dies. If, on the other hand, the surrounding fluid be a highly 
concentrated salt solution, the solution absorbs water from the 
cell, and no salt molecules enter into the cell body proper. The 
cell contracts and finally dies. This process of cell death is 
in general pathology referred to as necrobiosis. Another im- 
portant factor teaches that all aqueous solutions that are isotonic 
possess the same freezing point — that is, all solutions possessing 
an equal freezing point are equimolecular, and possess equal 
osmotic pressure. This law of physical chemistry has materially 
simplified the preparation of such solutions. The freezing point 
of human blood, lymph, serum, etc., has been found to equal ap- 
proximately 0.55° C, which in turn corresponds to a 0.9-percent 
sodium chlorid solution. Such a solution is termed a physiologic 
salt solution. In the older works on physiology a 0.6-percent 
sodium chlorid solution is referred to as a physiologic salt solu- 
tion, and corresponds to the density of the blood of the frog. A 
slight deviation above and below the normal percentage of the 
solid constituents is permissible. When physiologic salt solution 
at body temperature is injected into the loose connective tissues 
under the skin in moderate quantities, neither swelling nor 



PHYSIOLOGIC ACTION OP ANESTHETICS. 451 

shrinking of the cell occurs. A simple wheal is formed, which 
soon disappears, and, as no irritation results, consequently no ap- 
preciable pain is felt. Other similar bodies that are equally solu- 
ble in water act in the same manner, with the exception of the 
salts of the alkali and alkaline earth metals — as potassium or 
sodium bromid. The latter substances produce intense physical 
irritation, followed, however, by prolonged anesthesia, and in 
consequence are termed by Liebreich painful anesthetics. If, on 
the other hand, simple distilled water is injected, only a superficial 
anesthesia is produced; the injection itself is very painful, and 
acts as a direct protoplasm poison by maceration of the cell con- 
tents, which results in the death of the cell. If distilled water 
approximately at a ratio of 10 drams to the pound of body 
weight is injected into dogs, they will succumb in a short time. 
The injection of higher concentrated salt solutions produces op- 
posite effects ; water is removed from the tissues with more or less 
pronounced pain, and followed by superficial anesthesia. Severe 
tissue disturbances result, which may terminate in gangrene. 
Hypotonic solutions — solutions containing less than 0.9 percent 
of sodium chlorid — cause swelling of the tissue, while hypertonic 
solutions — solutions containing more than 0.9 percent of sodium 
chlorid — produce shrinkage. These manifestations are propor- 
tionately the more intense the further the solution is removed 
from the freezing point of the blood. Furthermore, hypotonic 
as well as hypertonic solutions require much more time for their 
absorption than isotonic solutions, as the osmotic pressure has to 
be standardized to the surrounding fluids — that is, to the isotonic 
index of the tissue fluids. 

Local anemia, or ischemia — a temporary constriction of circu- 
lation — prevents, as it has been experimentally shown, the rapid 
absorption of fluids that are injected into the affected area. Re- 
tarded absorption of the injected fluid, holding poisonous drugs 
in solution, means increased action of these poisonous drugs 
within the injected area. Increased action denotes increased 
consumption of the poisonous drugs, and, as a consequence, there 
is less danger from general absorption. The more important 
means applied for the purpose of producing local anemia are: 



452 LOCAL ANESTHESIA. 

1. The Esmarch elastic bandage. 

2. The application of cold. 

3. The extract of the suprarenal capsule, or its synthetic sub- 
stitutes. 

Some observers have maintained that local anemia produces 
anesthesia. This is not, however, the case, as it is merely an 
important means to confine the injected anesthetic to the anemic 
region, and thus bring about an increased and prolonged action 
of the drug. Consequently the concentration of the anesthetic 
solution may be of a lower percentage, which, of course, lessens 
the danger of intoxication. For plausible reasons the Esmarch 
elastic bandage can not be made use of for dental operations. 

Physically reducing the temperature of the body by the appli- 
cation of cold (ice pack, ice and salt mixture, cold metals, etc.) 
was practiced by the older surgeons. Arnott, in 1849, and Blum- 
dell, in 1855, advocated ice packs for the painless extraction of 
teeth. Through the efforts of Sir B. W. Richardson, in 1866, 
this method was placed on a rational basis by the introduction 
of his ether spray. To obtain good results, a pure ether (boiling 
point 95° F., 35° C), free from water, is necessary. Certain 
other hydrocarbons possess similar properties in varying degrees, 
depending on their individual boiling point. In 1867 Rotten- 
stein called attention to the use of ethyl chlorid as a refrigerating 
agent, and Rhein, in 1889, introduced methyl chlorid for the 
same purpose. In 1891 Redard reintroduced ethyl chlorid as a 
local anesthetic, which since has become known by many trade 
names — as antidolorine, kelene, narcotile, etc. — and mixtures of 
the first two in various proportions, known as anestol, anestile, 
coryl, metethyl, etc., are extensively used in minor oral and gen- 
eral surgery. A pure ethyl chlorid (boiling point 55° F., 13° C.) 
is best suited for this purpose, as it lowers the temperature of the 
tissues sufficiently to produce a short superficial anesthesia in a 
few minutes. Too rapid cooling or prolonged freezing by methyl 
chlorid (boiling point — 12° F., — 24.5° C), or the various mix- 
tures thereof, produce deeper anesthesia, but such procedures are 
dangerous. They frequently cut off circulation in the affected part 
so completely as to produce sloughing (gangrene) . Liquid nitrous 



PHYSIOLOGIC ACTION OF ANESTHETICS. 



453 



oxid gas, liquid or solid carbonic acid (recently known as carbonic 
acid snow) , and liquid air, all of which have a boiling point far 
below zero, are recommended for similar purposes, but they re- 
quire cumbersome apparatus and are extremely dangerous. 

Ethyl Chlorid and Its Administration. 

Ethyl Chlorid. — Monochlorethane ; hydrochloric ether, 
C 2 H 5 C1. "A haloid derivative, prepared by the action of hydro- 
chloric acid gas on absolute alcohol." At normal temperature, 
ethyl chlorid is a gas, and under a pressure of two atmospheres it 
condenses to a colorless, mobile, very volatile liquid, having a 




Figure 70. 
Ethyl Chlorid Spray Tube (Glass). 



characteristic, rather agreeable, odor and burning taste. It boils 
at about 55° F. (13° C), and is very inflammable, burning with 
a smoky, green-edged flame. It is stored in sealed glass or metal 
tubes, and when liberated at ordinary room temperature (70° F., 
21° C.) it evaporates at once. In commerce it is supplied in 
plain or graduated glass tubes of from 3 to 60 grams capacity, or 
stored in metallic cylinders holding from 60 to 100 grams or 
more. To remove the ethyl chlorid from the hermetically sealed 
smaller tubes, the neck has to be broken off, while the larger 
glass and metallic tubes are provided with suitable stop cocks of 
various designs to allow definite amounts of the liquid to be re- 
leased. 



454 



LOCAL ANESTHESIA. 



Mode of Application. — For the extraction of teeth, imme- 
diate removal of the pulp, opening of abscesses, and other minor 
operations about the oral cavity, the tube should be warmed to 
body temperature by placing it in heated water, and its capillary 
end should be held about six to ten inches from the field of 
operations. The distance depends on the size of the orifice of 
the nozzle, and complete vaporization should always be produced. 
The Gebauer tube is fitted with a spray nozzle, which shortens 
the distance to one to two inches, and is especially well adapted 
for dental purposes. The stream is directed upon the tissues 
until the latter are covered with ice crystals and have turned 
white. For the extraction of teeth the liquid should be pro- 
jected directly upon the surface of the gum, as near to the apex 




Figure 71. 
Ethyl Chlorid Spray Tube (Metal). 



of the root as possible, but care should be taken to protect the 
crown of the tooth on account of the painful action of cold on 
this part, Tissues to be anesthetized should first be dried and well 
surrounded by a film of vaselin or glycerin, and protected by cot- 
ton rolls and napkins, to prevent the liquid from running into 
the throat. Let the patient breathe through the nose. Occasionally 
light forms of general anesthesia are induced by inhaling the 
vapor. On account of the difficulty of directing the stream of 
ethyl chlorid upon the tissues in the posterior part of the mouth, 
it is not successfully applied in those regions. The intense pain 
produced by the extreme cold prohibits its use in pulpitis and 
acute pericementitis. To anesthetize the second and third branch 
of the fifth nerve, it is recommended to direct the stream of ethyl 
chlorid upon the cheek in front of the tragus of the ear, but the 



PHYSIOLOGIC ACTION OF ANESTHETICS. 



455 



author has not seen any good results from such a procedure. Cau- 
tion should be exercised in using ethyl chlorid near an open flame 




Figure 72. 
Application of the Ethyl Chlorid Spray, 



or in conjunction with the thermo-cautery, as severe burns have 
resulted by setting the inflammable vapor on fire. 



456 LOCAL ANESTHESIA. 

Active Principle of the Suprarenal Capsule and Its 
Synthetic Substitutes. 

Within the last decade the active principle of the suprarenal 
capsule has evoked extensive comments in therapeutic literature. 
It has been isolated by a number of investigators under different 
names, as epinephrin by Abel (1897), suprarenin by Fuerth 
(1898), and adrenalin by Takamine and Aldrich (1901). Many 
other titles are given to this chemical — as adnephrin, adrin, para- 
nephric suprarenalin, hemostasin, epinephrin, etc. The United 
States Pharmacopeia (eighth ravision) has not as yet admitted this 
alkaloid to its contents, and therefore, whenever we refer in these 
pages to the hydrochloric salt of the alkaloid of the suprarenal 
capsule, we speak of it as adrenalin, the term which is at present 
preferred in the United States. Adrenalin is a grayish-white pow- 
der, slightly alkaline in reaction, and perfectly stable in dry form. 
It is sparingly soluble in cold and more soluble in hot water, is in- 
soluble in ether or alcohol, and with acids it readily forms soluble 
salts. The preparation that is employed mostly for therapeutic 
purposes is a solution of adrenalin hydrochlorid in a 1:1000 
physiologic salt solution, to which preservatives — as small quan- 
tities of chloretone, thymol, etc. — are added. Adrenalin solution 
does not keep well. On exposure to air it is easily oxidized, be- 
coming pink, then red, and finally brown, and with this change 
of color its physiologic property is destroyed. If the adrenalin 
solution be further diluted, it becomes practically worthless within 
a few days. 

When adrenalin is injected into the tissues, even in extremely 
small doses, it temporarily raises the arterial blood pressure, act- 
ing as a powerful vaso-constrictor by stimulating the smooth mus- 
cular coat of the blood vessels, and thus produces local anemia. 
Large doses finally reduce the blood pressure, and heart failure re- 
sults. The respiration at first quickly increases, but slows down 
and finally stops with expiration. Its action is largely confined to 
the smooth muscle fibers of the peripheral vessels. Adrenalin is 
destroyed by the living tissue cells, the body ridding itself of the 
poison in some unknown manner. While adrenalin does not pos- 



PHYSIOLOGIC ACTION OF ANESTHETICS. 457 

sess local anesthetic action, it increases very markedly the effect of 
certain anesthetics when combined with them. These observations 
are of vast importance in connection with the production of 
local anesthesia. Carpenter, 1 Peters, 2 Moller, 3 and others re- 
ferred to the use of adrenalin in this respect, and finally Braun, 4 
in 1902, published his classic researches, and to him and his co- 
workers, specially Heinze and Lawen, 5 belongs the credit of estab- 
lishing a rational basis for the production of local anesthesia. It 
is claimed that secondary hemorrhage frequently occurs after the 
anemia produced by the adrenalin has subsided, and that the tis- 
sues themselves suffer from the poisoning effects of the drug, re- 
sulting in gangrene. Such results are produced only by the in- 
jection of too large quantities of the drug, which by their deeper 
action close up the larger arteries. The prolonged anemia will 
give way to a dilatation of the blood vessels, and, if the tissues are 
too long deprived of the circulation, we are able to understand 
why sloughing may result. Small doses of adrenalin have no 
effect upon the tissues or on the healing of a wound. Palpitation 
of the heart and muscular tremor, which were occasionally noticed 
in the early period of the use of the drug, are the direct result of 
too large doses. Recently a synthetic adrenalin has been success- 
fully prepared by Stolz, 6 which, with hydrochloric acid, forms a 
stable and readily soluble salt. It is marketed by the Farbwerke 
vormals Meister, Lucius, und Bruning, Hochst-am-Main, Ger- 
many, as synthetic suprarenin hydrochlorid. The new chemical 
has been carefully tested physiologically and in clinical work, and 
the general consensus of opinion points to the fact that it is not 
alone equal, but in certain respects superior, to the organo prepara- 
tions. Synthetic suprarenin solutions may be readily sterilized 
by boiling. They are relatively stable, and their chemic purity 
insures uniform results. They are comparatively free from dan- 
gerous side actions. Our own observations regarding the value of 
synthetic suprarenin relative to its actions and its general behavior 



1 Carpenter: Dental Review, 1901, No. 6. 

2 Peters: British Journal of Dental Science, 1902. 

3 Moller: Deutsche Monatsschrift fur Zahnheilkunde, 1902, No. 9, 

4 Braun: Archiv fur Klinische Chirurgie, 1902, p. 69. 

5 Lawen: Archiv fur Experimentale Pathologie, 1904, Vol. II. 

6 Stolz: Bericht der Chemischen Gesellschaft, 1904, p. 4149. 



458 LOCAL ANESTHESIA. 

is in full accordance with the above statements, and its advantages 
over the organo preparations has led us to adopt it exclusively as 
a component in the preparation of local anesthetic solutions. For 
dental purposes — that is ; for injecting into the gum tissue — the 
dose may be limited to one drop of the adrenalin solution (1:1000) 
or the synthetic suprarenin solution (1:1000) added to each cubic 
centimeter of the anesthetic solution, five drops being approxi- 
mately the maximum dose to be injected at one time. 

LOCAL ANESTHETICS. 

Ever since the introduction of cocain into materia medica for 
the purpose of producing local anesthesia, quite a number of sub- 
stitutes have been placed before the profession, for which superi- 
ority in one respect or another is claimed over the original cocain. 
The more prominent members of this group are tropa-cocain, the 
eueains, acoin. nirvanin. alypin, stovain, and novocain. None 
of these compounds, with the exception of novocain, has proven 
satisfactory for the purpose in view. The classic researches of 
Braun have established certain factors that are essential as regards 
the value of a local anesthetic. The principal properties of a 
modem local anesthetic must correspond to the following claims : 

In comparison with its local anesthetic value, it must be less 
toxic than cocain, and the difference of toxicity must be absolute — 
that is, the quantity of the chemical necessary to produce the same 
anesthetic effect as a definite quantity of cocain must be less toxic 
to the amount of body weight. 

The chemical must be absolutely indifferent to the tissues when 
injected in more or less concentrated solutions, and the progress of 
wound healing must not be interfered with by the solution. 

The chemical must be readily soluble in water, the solution 
must be comparatively stable, and it should be possible to sterilize 
it by simple means. 

The chemical must be tolerant to the additions of adrenalin 
without interfering with the vaso-constrictor power of the latter 
drug. 

When applied to mucous surfaces, ready penetration of the 
chemical is necessary. 



LOCAL ANESTHETICS. 459 

There is at this moment no need to enter into the pharmaco- 
logic action of the drugs usually classified as loeal anesthetics. 

Let it suffice to state how the above-mentioned chemicals fulfill 
the demands of Braun. Tropa-coeain is less poisonous, but also 

le.ss active, than cocain, and completely destroys the action 'of 
adrenalin. The eucains partially destroy the adrenalin action, and 
are, comparatively speaking, equally as poisonous as cocain. Acoin 
\s irritating to the tissues, and much more poisonous than cocain. 
Xirvanin possesses little anesthetic value. Alypin and stovain are 
closely related, and when injected they produce severe pain and 
occasionally gangrene. Novocain fully corresponds to every one 
of the above claims; its toxicity is about six to seven times less 
than cocain; it does not irritate in the slightest degree when in- 
jected, and consequently no pain is felt from its injections, per se; 
it is soluble in its own weight of water; it will combine with 
adrenalin in any proportion without interfering with the physio- 
logic action of the latter, and is readily absorbed by the mucous 
membranes. 

The studies of Biberfeld 1 and Braun brought to light another 
extremely interesting factor concerning the novocain-adrenalin 
combination. Both experimenters, working independent of each 
other, observed that the adrenalin anemia on the one hand and 
the novocain anesthesia on the other hand were markedly in- 
creased in their total effect on the tissues. Consequently a smaller 
quantity of this most happy combination is required to produce 
the same therapeutic effect than a larger dose of each drug alone 
would produce when injected separately; besides, the injection of 
a solution of the combined drugs is confined precisely to the 
injected area. 

The relative toxicity of a given quantity of cocain solution de- 
pends on the concentration of the solution. Reclus 2 and others 
have clearly demonstrated that a fixed quantity of cocain in a 
5 to 10-percent solution is almost equally as poisonous as five 
times the same quantity in a Vg-percen! solution. From the 
extensive literature on the subject we are safe in fixing the strength 



1 Biberfeld: Medizinische Klinik, 1905, No. 48. 

2 Reclus: L'Anesthesie Locale par la Cocaine, 1905. 



460 LOCAL ANESTHESIA. 

of the solution for dental purposes at 1 percent. This quantity 
of cocain raises the freezing point of distilled water just a little 
above 0.1° C. To obtain an isotonic solution corresponding to the 
freezing point of the blood, 0.8 percent of sodium chlorid must 
be added. Having thus prepared a cocain solution which is equal 
to the blood in its osmotic pressure on the cell wall, it is now neces- 
sary to aid the slightly vaso-constrictor power of the drug by the 
addition of a moderate quantity of adrenalin, thus increasing the 
confinement of the solution to the injected area by producing a 
deeper anemia, for a two-fold purpose — first, to act as a means of 
increasing the anesthetic effect of cocain, and, second, to lessen its 
toxicity upon the general system by slower absorption. As stated 
above, 2 drops of adrenalin solution added to 2 cubic centimeters 
of the isotonic cocain solution is sufficient to produce the desired 
effect. 

A suitable solution for dental purposes may be prepared as 
follows : 

Cocain hydrochlorid 5 grains (0.3 Gm.). 

Sodium chlorid 4 grains (0.25 Gm.). 

Sterile water . . 1 fluidounce (30 Cc.) . 

To each syringeful (2 Cc.) add two drops of adrenalin solution 
when used. 

As stated above, the relative toxicity of a given quantity of 
cocain in solution depends on its concentration, but this peculiarity 
is not shared by novocain. The dose of novocain may be safely 
fixed at one-third of a grain for a single injection. For dental pur- 
poses a 2-percent solution is preferably employed, and as much as 
three grains of a 2-percent solution in combination with adrenalin 
have been injected without any ill results. For the purpose of 
confining the injected novocain to a given area, the addition of 
adrenalin in small doses on account of its powerful vaso-constrictor 
action is admirably adapted. It is the important factor which 
prevents the ready absorption of both drugs. An injection of 5 
drops of a simple 2-percent solution of novocain labially into the 
gum tissue produces a diffuse anesthesia, lasting approximately 
twenty minutes ; the same quantity with the addition of one drop 
of adrenalin solution increases the anesthetic period to about one 
hour and localizes the effect upon the injected area. 



LOCAL ANESTHETICS. 461 

A suitable solution of novocain for dental purposes may be pre- 
pared as follows : 

Novocain 10 grains (0.6 Gm.). 

Sodium chlorid 4 grains (0.25 Gm.) . 

Distilled water 1 fluidounce (30 Cc.) . 

Boil the solution. 

To each syringeful (2 Cc.) add two drops of adrenalin solution 
when used. 

Ready-made solutions of cocain and, to some extent, of 
novocain will not keep when frequently exposed to the air. A 
perfect sterile solution may be made extemporaneously by dissolv- 
ing the necessary amount of novocain-suprarenin in tablet form 
in a given quantity of boiled distilled water. A suitable tablet 
may be prepared as follows : 

Novocain Vs grain (0.022 Gm.) . 

Suprarenin hydrochlorid, synthetic. . . . Vboo grain (0.000054 Gm.). 
Sodium chlorid Vs grain (0.008 Gm.). 

One tablet dissolved in 20 minims of sterile water makes a 
2-percent solution of novocain ready for immediate use. 

Preparation of the Anesthetic Solution. 

Solutions for hypodermic purposes should be made fresh when 
needed. A small glass dish and a dropping bottle constitute the 




Figure 73. 
Glass Dish for Mixing Anesthetic Solution. 



simple outfit for this work, The dropping bottle should hold 
from one to two ounces. It is made by the Whitall-Tatum Com- 



462 



LOCAL ANESTHESIA. 



pany cf Philadelphia, and it, as well as the glass dish ; may be 
procured from dental depots. A groove on one side of the neck 
of the bottle and a vent on the other connected with two grooves 
in the back of the stopper allow the contents to flow out drop by 
drop. A quarter turn of the stopper closes the bottle tightly. Re- 
cently Ash & Sons have placed on the market a graduated glass 
measure for making hypodermic solutions, and it is very service- 




FlGURE 74. 
Dropping Bottle. 



able for this purpose. The water used for making the solution 
should be boiled and filtered distilled water. 

The hypodermic solution can be made extemporaneously in a 
few seconds as follows: Place a tablet in a sterile glass dish, add 
20 minims (1 Cc.) of water, and, to facilitate the solution, mash 
the tablet. The solution is now ready for immediate use. 

Ready-made sterile solutions of local anesthetics are also sold 
at present, and are marketed in hermetically sealed ampuls of 
various designs. To open the ampul, a small groove is made with 



LOCAL ANESTHETICS. 



463 



a file at one end, which is then readily broken off. The contents 
are aspirated by inserting the syringe provided with the needle 
directly into the opened ampul. 

The practitioner is especially cautioned in regard to the use of 
local anesthetics in the form of ready-made solutions. Solutions 
of cocain, even when rendered sterile by fractional sterilization, 
will not remain so after the contents of the bottle are exposed to 
the air for a short time. 

Ready-made solutions that are sold in the shops under more or 




Figure 75. 

Glass Measure for Local Anesthetics. The measure is marked for 10, 20, 30, or 40 minims. 
It is useful for measuring- anesthetic solutions, or for dissolving- tablets in stipulated quantities 
of liquids. 

less fanciful names require still greater precaution. The recently 
(1906) enacted Food and Drugs Act requires that all solutions 
containing cocain, eucain, and other similar alkaloids must be so 
labeled. Most of the many so-called safe and reliable anesthetics 
found in the market contain cocain or its substitute in varying 
quantities. The addition of adrenelin to a ready-made solution 
not only destroys this alkaloid in a very short time, but the product 
of its decomposition with the decomposed cocain make the solution 



464 



LOCAL ANESTHESIA. 



still more dangerous. The printed formulas that 'accompany 
many of the ready-made solutions of local anesthetics frequently 




Figure 76. 
Hermetically Sealed Glass Ampuls of Various Types. They contain sterile anesthetic solutions. 

show an utter disregard of the pharmacologic action of the indi- 
vidual ingredients, which forces us to conclude that they are a slur 
on the intelligence of the practitioner who uses such compounds. 



HYPODERMIC ARMAMENTARIUM. 

A hypodermic syringe that answers all dental purposes equally 
well is an important factor in carrying out the correct technique of 
the injection. The injection into the dense gum tissue requires 
from 15 to 50, or even more, pounds of pressure as registered by 
an interposed dynamometer, while in pressure anesthesia 100 or 
more pounds are frequently applied. 

The selection of a suitable hypodermic syringe is largely a mat- 
ter of choice. All-glass syringes, glass-barrel syringes, and all- 
metal syringes are the usual types found in the depots. If an all- 
glass syringe is preferred, the "Sub-Q" deserves to be mentioned. 
Its glass screw-top is, however, very frail, and frequently breaks 
by screwing the needle tightly into position. An all-glass syringe 



HYPODERMIC ARMAMENTARIUM. 



465 



that answers every demand regarding asepsis, durability, and per- 
fect construction, and that is giving universal satisfaction, is made 
by Burroughs "Wellcome & Co. All parts of the syringe are ground 
so perfectly that no screws are required to make absolute water- 
tight joints. A wire finger grip is easily slipped over the assembled 




_ 



Figure 77. 
"Sub-Q" All-Glass Syringe. 



syringe, which greatly assists in exerting pressure on the piston. 
When the glass syringes are not in use, the piston, needle, and 
other parts should be kept detached. The asbestos packing of the 
"Sub-Q" syringe must be thoroughly wet before it is pushed into 



466 



LOCAL ANESTHESIA. 



the barrel to prevent leaking or breaking. Glass-barrel syringes 
are not to be recommended for dental purposes, as they are too 




Figure 78. 
Aseptic All-Glass Syringe. 



troublesome to keep in order, and an all-metal syringe is best 
adapted for this work. After carefully testing most of the dental 



HYPODERMIC ARMAMENTARIUM. 



467 



hypodermic syringes offered in the dental depots within the last 
five years by means of the pressure gauge and in clinical work, sub- 




FlGURE 79. 

Manhattan All-Metal Syringe. 



jecting the syringes to a routine wear and tear, the author has 
found that the all-metal syringes of the "Imperial" type are to 



468 



LOCAL ANESTHESIA. 



be preferred over other makes. They are usually made of nickel- 
plated brass, which, however, is a disadvantage, as the nickel 




Figure 80. 
All-Metal Syringe. 



readily wears off from the piston, and exposes the easily corroded 
brass. The Manhattan all-metal platinoid syringe gives the best 



HYPODERMIC ARMAMENTARIUM. 469 

general service, and we can conscientiously recommend it to our 
confreres. The syringe holds 40 minims (2 Cc.) , is provided with 
a strong finger cross-bar, and is extremely simple in construction. 
The piston consists of a plain metal rod, without a thickened or 
ground piston-end or packing. The piston-rod is sufficiently long 
to allow about two inches of space between the cross-bar and the 
piston-top. This space is of importance, as it allows the last drop 
of the fluid to be expelled under heavy pressure without tiring the 
fingers. The packing consists of leather washers inserted at the 
screw joint, and is quickly removed and replaced if necessary. 
Recently an all-metal syringe has been brought out by Parke. 
Davis & Co., in which the author's suggestion regarding a cane- 
handle, or crotch-handle, has been made use of. This syringe is 
provided with the "Schimmel" aseptic needles and a right-angle 
attachment for the latter. 

The hypodermic syringe requires careful attention. It is not 
necessary to sterilize it by boiling after each use, unless it should 
be contaminated with blood or pus. The simple repeated wash- 
ings with alcohol and careful drying is sufficient. The cap is 
readjusted, and the piston-rod is covered with a thin film of car- 
bolated vaselin, or surgical lubricating jelly, and placed in posi- 
tion. If the syringe is boiled, all the washers must be removed. 
The syringe is best kept in a covered glass or metal case, and a large 
bacteriologic Petri dish is suitable for this purpose. Leather-lined 
or felt-lined boxes afford breeding places for bacteria. Some opera- 
tors prefer to constantly keep their syringes in an antiseptic solu- 
tion when not in use, and others prefer to place them in a special 
sterilizing bottle, which bottles may now be purchased at dental 
depots. A suitable sterilizing liquid for this purpose may be made 
as follows: 

Cresol 1 part. 

Alcohol 25 parts. 

Water enough to make 50 parts. 

Dental hypodermic needles should be made preferably of scam- 
less steel, or, still better, of nickel-steel, 26 to 28 B. & S. gauge, and 
provided with a short razor edge point. Thicker needles cause 
unnecessary pain, and thinner needles are liable to break. Iridio- 



470 



LOCAL ANESTHESIA. 



platinum needles are preferred by some operators, as they may be 
readily sterilized in an open flame. 

The needle should measure from a quarter to a half inch. For 
infiltration anesthesia one-inch needles are necessary, and curved 



Figure 81. 

Dental Hypodermic Needles, a, incorrectly ground needle point; 6, correctly ground needle 
point. 

needles of various shapes are essential in reaching the posterior 
parts of the mouth. The "Schimmcl" needles are excellent, but 
do not, however, fit every syringe. For pressure anesthesia special 






Figure 82. , 

Hypodermic Needles of Various Designs for Dental Purposes. 



needles are required, and may be bought at the depots, or quickly 
prepared by grinding off the steel needle at its point of reinforce- 
ment. The sterile needle should be kept in well-protected glass 



TECHNIQUE OF THE INJECTION. 



471 



containers. The needles are sterilized by boiling after each use in 
a 2-percent lysol or cresol solution, dried with the hot air syringe, 
and immediately transferred to a sterile glass bottle. The sterile 
needles should not be again touched with the fingers, and the cus- 




FlGURE 83. 

Needle Attachments for Parke, Davis & Co.'s Syringe. A, butt and adapter with Schimmel 
needle; B, cross section of butt and adapter with Schimmel needle; c, Schimmel needle; D, tube 
of Schimmel needles; E, curved attachment for Schimmel needles; F, cross section of Schimmel 
needle enlarged; G, cap for syringe when not in use. 

tomary wire insertion is unnecessary. As stated, novocain is pre- 
cipitated from its solution by sodium carbonate. If soda is used for 
sterilizing purposes, the syringe and the needles must be washed 
with sterile water to remove any trace of sodium carbonate. 



TECHNIQUE OF THE INJECTION. 

Various methods of injecting the anesthetic solution about the 
teeth are in vogue. For the sake of convenience, we may be per- 
mitted to divide them as follows: 

The subperiosteal injection. 

The peridental injection. 

The intraosseous injection. 

The mandibular injection. 

The injection into the pulp. 



472 



LOCAL ANESTHESIA. 



Before starting any surgical interference in the mouth, the field 
of operation should be thoroughly cleansed and painted with tinc- 
ture of iodin. After the diagnosis is made the method of injec- 
tion best suited for the case on hand is then decided. The 
necessary quantity and the concentration of the anesthetic so- 
lution is now prepared, and the syringe and hypodermic needle 
fitted ready for the work. To facilitate the ready penetration 
of ihe needle into the tissues, its point may be dipped into car- 
bolated vaselin. The correct position of the syringe in the hands 
of the operator and its proper manipulation is an important factor, 
and has to be acquired by practice. The hand holding the 
syringe is exclusively governed in its movement by the wrist, 
so as to allow delicate and steady movements, and the fingers 
must be trained to a highly developed sense of touch. The 
syringe is filled by drawing the solution up into it ; it is held per- 
pendicularly, point up, and the piston is pushed until the first 
drop appears at the needle point, which precaution prevents the 
injection of air into the tissues. 

Before entering into a discussion of the various methods of 
the technique of the. injection, it is essential to recall to one's 
mind the anatomic structure of the alveolar process, as this fac- 
tor plays an important part in the distribution of the injection 
within the bone. 



Anatomic Structure of the Alveolar Process. 

Regarding the anatomic structure of the alveolar process of 
both jaws, it should be remembered that this bone is transitory 
in structure, becoming thinner with age, and is very readily ab- 
sorbed when the teeth are removed. The process is composed 
of soft, spongy cancelloid bone, which is penetrated by Haver- 
sian and Volkmann's canals (the latter carrying the vessels of 
Von Ebner) , and also contains lymph vessels. The anterior wall 
of the alveolar process of the maxilla is a thin plate throughout, 
except about the border of the molar teeth, while the posterior 
surface is reinforced by the intermaxillary bone and palatal 
processes. In the mandible the anterior portion is the thinnest 



TECHNIQUE OF THE INJECTION. 



473 



part, while in the molar regions the external and internal ob- 
lique lines materially increase the thickness of this bone. Fluids 
injected into the periosteum covering the alveolar process pene- 
trate the bone by diffusion, as Dzierzawsky 1 has experimentally 
shown by employing methylen blue injections, but this dif- 
fusion occurs only when the injected fluid is held under a certain 
pressure by the overlying tissues. Penetration through this bone 




Figure 84. 

Cross Sections of a Right Lower Jaw. They show the mesial surfaces of the teeth and their 
relation to the bone structure. (Loos.) 



can not be expected from an injection into a loose mucosa, from 
which the fluid is, sponge like, absorbed. This factor explains 
the failure of the infiltration method of Schleich when applied 
about the alveolar process. 

The nerve supply of the anterior surface of the maxilla, in- 
cluding the teeth and gum tissue, is received from branches of the 



1 Dzierzawsky: See Braun, Die Lokalanasthesie, 1904. 



474 



LOCAL ANESTHESIA. 



second division of the fifth nerve, known as the superior maxil- 
lary. The nerve divides into the posterior, middle, and anterior 
superior dental branches. The posterior branch supplies the 
molar teeth, the gums, and adjacent buccal mucosa, while smaller 
branches terminate in the canine fossa; the middle branch passes 
along the outer wall of the maxillary sinus, supplying the bicus- 
pid teeth; and the anterior branch, the largest, passes through 
a canal close to the infra-orbital foramen over the anterior wall 
of the maxillary sinus, and distributes its filaments to the incisor 




Figure 85. 
Horizontal Section Through the Alveolar Process of the Lower Jaw. (Loos.) 

and cuspid teeth. All the branches communicate with each other 
about the alveolar process. 

The hard palate, the periosteum, and the palatine gum tissue 
receive their innervation from the anterior palatine nerve from 
Meckel's ganglion, which enters through the posterior palatine 
foramen and the accessory palatine canals, passing forward in a 
groove and joining anteriorly with the naso-palatine nerve as it 
emerges from the anterior palatine foramina of Scarpa. 

The mandible receives its nerve supply from the largest of 



TECHNIQUE OF THE INJECTION. 



475 



the three divisions of the fifth nerve, known as the mandibular 
branch or the inferior dental nerve. "From its point of origin 
it passes downward internally to the external pterygoid muscle, 
and, upon reaching a point between the ramus of the mandible 
and the sphenomandibular ligament, it enters the inferior dental 
canal through the posterior or inferior dental foramen. Before 




Figure 86. 
The Nerve Supply of the Upper and Lower Jaw. 



entering the foramen, two branches are given off — a lingual and 
a mylohyoid branch. The nerve is accompanied through the 
inferior dental canal by the inferior dental artery, and, when 
the mental foramen is reached, it terminates by dividing into 
an incisive and a mental branch. Between the dental foramen 
and the mental foramen the nerve gives off a series of twigs to 
the bicuspid and molar teeth, and, by communicating with one 



476 



LOCAL ANESTHESIA. 



another within the substance of the bone, forms a fine plexus. 
The incisive branch follows the incisive arteries through the 
substance of that part of the bone between the mental foramen 




Figure 87. 
The Nerve and Blood Supply of the Hard Palate. 

and the symphysis, and supplies the incisor and cuspid teeth, 
while the mental branch passes forward to supply the chin and 
lower lip." (Broomell.) 



Subperiosteal Injection. 

The subperiosteal injection about the root of an anterior tooth 
is best started by inserting the needle midway between the gin- 
gival margin and the approximate location of the apex. Nothing 
is more dreaded by the patient than this first puncture. A fine, 
very sharp-pointed needle causes very little pain, and the sim- 
ple compression of the gum tissue with the finger tip is often 
quite effective. The pain may be entirely obviated by holding 
a pledget of cotton saturated with the prepared anesthetic solu- 
tion on the gum tissue for a few moments, or by applying a 



TECHNIQUE OF THE INJECTION. 



477 



very small drop of liquid phenol on the point of puncture. The 
needle opening faces the bone, the syringe is held in the right 
hand at an acute angle with the long axis of the tooth, while the 
left hand holds the lip and cheek out of the way. After punctur- 
ing the mucosa, a drop of the liquid is at once deposited in tlie 
tissue, and the further injection is painless. Slowly and steadily 
the needle is forced through the gum tissue and periosteum along 
the alveolar bone toward the apex of the tooth, depositing the 
fluid under pressure close to the bone on its upward and return 




Figure 88. 
Position of Needle for Injecting About an Upper Central Incisor. 



trip — V injection tracante et continue, as Reclus calls it. The 
continuous slow moving of the needle prevents injecting into a 
vein. A second injection may be made by partially withdrawing 
the needle from the puncture and swinging the syringe anteriorly 
or posteriorly, as the case may be, from the first route of the 
injection. This latter method is especially indicated in inject- 
ing the upper molars. After removing the needle, place the finger 
tip over the puncture and slightly massage the injected area. A 
circular elevation outlines the injected field. The naturally pink 
color of the gum will shortly change to a white anemic hue, in- 
dicating the physiologic action of the adrenalin on the circula- 



478 LOCAL ANESTHESIA. 

tion. No wheal should be raised by the fluid, as that would in- 
dicate superficial infiltration and consequently failure of the 
anesthetic. . 

As the liquid requires a definite length of time to pass through 
the bone lamina and to reach the nerves of the peridental mem- 
brane and the pulp, from five to ten minutes should be allowed 
before the extraction is started. The length of time depends on 
the density of the surrounding structure of the tooth. The prog- 
ress of the anesthesia may be tested with a fine-pointed probe, 
and its completeness indicates the time when the extraction 
should be started. 




Figure 89. 
Position of Needle for Injecting About a Lower Incisor. 

The upper eight anterior teeth usually require a labial injec- 
tion only, while the molars require both a buccal and a palatine 
injection, using a slightly curved needle for this purpose. Buc- 
cally the injection is made midway between the mesial and dis- 
tal root, and on the palatine side over the palatine root. 

The lower eight anterior teeth are comparatively easily reached 
by the injection. The straight needle is inserted near the apex 
of the tooth, the syringe is held in a more horizontal position, and 
the injection proceeds now as outlined above. 

The lower molars require a buccal and lingual injection. The 
curved needle is inserted midway between the roots, the gum mar- 



TECHNIQUE OF THE INJECTION. 479 

gin, and the apices. The external and internal oblique lines ma- 
terially hinder the ready penetration of the injected fluid, and 
therefore ample time should be allowed for its absorption. 

For anatomical reasons the lower third molar presents the 
greatest obstacle to a successful injection, but may be fairly well 
accomplished by using a curved needle. The peridental, the 
intraosseous, or the mandibular injection, according to circum- 
stances, as outlined below, are, however, greatly to be preferred 
for this tooth. 




Figure 90. 
Position of Needle for Injecting About an Upper First and Second Molar. 

If two or more adjacent teeth are to be removed, the injection 
by means of infiltrating the area near the gum fold directl/ over 
the apices of the teeth is to be preferred. It is advisable to use 
a half-inch needle for this purpose, holding the syringe in a 
horizontal position, so as to reach a larger field with a single in- 
jection. If all the teeth of one jaw are to be removed at one sit- 
ting, from two to four injections, using two or three tablets dis- 
solved in from two to five cubic centimeters of water, may be 
necessary, according to circumstances; for the complete anes- 



480 



LOCAL ANESTHESIA. 



thetization of a single-rooted tooth, one tablet of the novocain- 
suprarenin compound is sufficient; and for the molars, one and, 
according to conditions, two tablets may be required. The quan- 
tity of novocain to be injected at one sitting should be limited 
to three tablets (one grain). 

It should be borne in mind that the absorption of fluids in- 
jected into the gum tissue is more quickly accomplished than in 
most other tissues of the body. 

The injection into inflamed tissue, into an abscess, and into 




Figure 91. 
Position of Needle for Injecting About an Upper Third Molar. 



phlegmonous infiltration about the teeth is to be avoided. The 
injection into engorged tissue is very painful; the dilated vessels 
quickly absorb cocain without producing a complete anesthesia, 
and general poisoning may be the result. In purulent condi- 
tions the injection is decidedly dangerous, as it forces the in- 
fection beyond the line of demarcation. If the abscess presents 
a definite outline, the injection has to be made into the sound 
tissue surrounding the focus of infiltration. If a tooth is affected 
with acute diffuse or purulent pericementitis, a distal and a mesial 
injection usually produce successful anesthesia by blocking the 



TECHNIQUE OF THE INJECTION. 481 

sensory nerve fibers in all directions. Ethyl chlorid in connec- 
tion with the injection is frequently helpful, but a painless ex- 
traction should not, however, be promised in such cases. Gen- 
eral anesthesia by means of nitrous oxid gas is to be recommended 
if the patient demands an absolutely painless operation. 

Some years ago Schleich introduced a special method for the 
purpose of thoroughly infiltrating the tissues with very weak 
isotonic cocain solutions. He injects the solution into the sub- 
cutaneous tissue, thereby raising a definite circular wheal ; he now 




Figure 92. 
Position of Needle for Injecting About a Lower Third Molar. 

inserts the needle in the anesthetized region, near the periphery 
of the wheal, injecting again and raising a second wheal, and 
thus he continues until a circle of wheals has been established 
which incloses a completely anesthetized surface. If deeper struc- 
tures are to be operated upon, the anesthetizing of these struc- 
tures by infiltration has to be performed in the same manner. 
The Schleich method can not be employed with any degree of 
success in the oral cavity, and in general surgery it is at present 
largely abandoned. Schleich deserves much credit for having 
worked out the basic principles of local anesthesia, and its subse- 
quent wide use in special and general surgery is largely due to his 
investigations. 



482 LOCAL ANESTHESIA. 

Peridental Anesthesia. 

Teeth or roots standing singly, or teeth affected by pyorrhea 
or similar chronic peridental disturbances, are frequently quickly 
and satisfactorily anesthetized by injecting the fluid directly 
into the peridental membrane. This method is known as peri- 
dental anesthesia, and its technique is very simple. In single- 
rooted teeth a fine and short hypodermic needle is inserted under 
the free margin of the gum, or through the interdental papilla, 
into the peridental membrane between the tooth and the alveolar 
wall. Sometimes the needle may be forced through the thin 
alveolar bone so as to reach the peridental membrane direct. To 
gain access to this membrane in teeth set close together, slight 
separation with an orange wood stick or other suitable means is 
often found to be of advantage. In molars two injections are 
essential. One puncture is made buccally between the bifurcation 
of the roots near the gum margin, and the same procedure is re- 
peated on the opposite side of the tooth. A drop of fluid is now 
deposited in the tissue, and the injection is slowly continued. 
To force the liquid into the membrane usually requires a higher 
pressure than that which is necessary for injecting into the peri- 
osteum covering the alveolar process, but the quantity of the anes- 
thetic liquid is less than that which is required for the former 
injection. Acute inflammatory conditions of the peridental mem- 
brane and its sequela? prohibit the use of this method. In peri- 
dental anesthesia the seat of the nerve supply of the tooth is very 
quickly reached, and as a consequence the results obtained are 
in the majority of cases extremely satisfactory, provided that gen- 
eral conditions justify its application. 

Intraosseous Injection. 

To facilitate the passage of the injected fluid into the bone 
structure proper, Otte, 1 in 1896, recommended a method by 
which he forces the anesthetic solution directly into the spongy 
cancelloid bone. Otte terms this procedure the intraosseous 



1 Otte: Nederlandsche Tandmeesters Vereeniging, 1896. 



TECHNIQUE OF THE INJECTION. 483 

method of injection. When Otte's paper was published, the tech- 
nique of local anesthesia was in its infancy, and as a consequence 
his recommendations were soon forgotten. Nogue « in 1897 
again ca lled attention to it under the name of anesthesie dvphiqm ' 
This method is especially indicated in the anesthetization of lower 
molars because the dense bony ridges on both sides of the 
mandible materially interfere with the ready penetration of the 
mud. Ihe technique of the injection is described by Otte as fol- 
lows: After the gum tissue is thoroughly cleansed with an anti- 
septic solution., it is anesthetized about the neck of the tooth in 
the usual manner. After waiting two or three minutes, an open- 
ing is made into the gum tissue and the bone on the buccal side 
with a fine spear drill or a Gates-Glidden drill. The opening 
should be made more or less at a right angle with the long axis of 
the tooth, a little below the apical foramen in single-rooted teeth 
or between the bifurcation in the molars. The right-angle hand 
piece is preferably employed for this purpose. The drill should 
be of the same diameter as the hypodermic needle. The gum fold 
is tightly stretched to avoid laceration from the rapidly revolving 
drill. As soon as the alveolar process is penetrated, a peculiar 
sensation conveyed to the guiding hand indicates that the alve- 
olus proper is reached, and the sensation felt by the hand is about 
the same as that experienced when a burr enters into the pulp 
chamber. In this artificial canal the close-fitting curved needle 
of the hypodermic syringe is now inserted, and the injection is 
made in the ordinary way. The quantity of fluid used is much 
less than is usually needed for a subperiosteal injection. As has 
been stated above, the roots of the teeth are imbedded in a sieve- 
like mass of bone tissue, which allows a ready penetration of fluid 
when injected under pressure. Within ten minutes the peri- 
dental membrane and the pulp are sufficiently anesthetized to in- 
sure a painless extraction. If an inflammatory condition of the 
involved area exists, the injection should be made into the sound 
tissue— preferably distally of the tooth— and, if this should not 
be sufficient, another injection is made mesially of the tooth. As 
in all highly inflamed processes about teeth, an absolutely pain- 

1 Nogru€: Anesthesie Diploique, 1907. 



484 LOCAL ANESTHESIA. 

less extraction should not be promised in such cases. Otte's intra- 
osseous method of anesthetization involves a comparatively simple 
technique. After mastering its essential details, good results are 
universally obtained, and this method deserves to be recom- 
mended in suitable cases. 



Injection Into the Mandibular Nerve. 

The complete anesthetization of the third, and sometimes of 
the second, lower molar by the subperiosteal or by the intraosseous 
method is frequently fraught with much difficulty on account of 
the bony ridges on both sides of the teeth, and posteriorly by the 
compact bone of the ascending ramus, which forms a strong bar- 
rier to the ready penetration of the liquid into the bone. These 
difficulties are usually more pronounced in a malpost or an im- 
pacted third molar, while the same tooth standing alone seldom 
presents difficulties to the ordinary method of injection. In the 
latter case the tooth has more or less always moved toward the 
median line. To overcome these difficulties Braun, of Leipzig, in 
1905, introduced a method of centrally anesthetizing the man- 
dibular and incidentally the lingual nerve, which since is known 
as the conductive anesthesia of the mandibular nerve. In describ- 
ing the technique of the injection, the author has followed very 
closely Braun's description of this method. 

By palpating the lingual surface of. the ramus in the mouth 
with the finger, the anterior sharp border of the coronoid process 
is easily felt about five-eighths of an inch posterior of the third 
molar. The process passes downward and backward of the third 
molar, and enters into the external oblique line. Mesially from 
this ridge is to be found a small triangular concave plateau, which 
is facing downward and outward, being bound mesially by a dis- 
tinct bony ridge and covered with mucous membrane. As there 
is no anatomic name attached to this space, Braun has called it 
the retromolar triangle (trigonum retromolare) . In the closed 
mouth it is located at the side of the upper third molar, and in 
the open mouth it is found midway between the upper and lower 
teeth. Immediately back of the mesial border of this triangle, 



TECHNIQUE OF THE INJECTION. 



485 



directly beneath the mucous membrane, lies the lingual nerve 
and about three-eighths of an inch farther back the mandibular 
nerve is to be found. This last nerve lies close to the bone, and 
enters into the mandibular foramen, which is partially covered 
by the mandibular spine. 

Before starting the injection the patient should be cautioned 
to rest his head quietly on the headrest of the chair, as any sud- 
den movement or interference with the hand of the operator may 
be the cause of breaking the needle in the tissues. The syringe, 
provided with a one-inch needle, is held in a horizontal position, 




Figure 93. 
Position of Needle for Injecting- the Mandibular Nerve. 



resting on the occluding surfaces of the teeth from the cuspid 
backward and slightly toward the median line. The needle is to 
be inserted three-eighths of an inch above and the same distance 
back of the occluding surface of the third lower molar, the needle 
opening facing the bone. This position will insure the correct 
direction of the needle point so as to reach the tissues imme- 
diately surrounding the nerves, and not lose the injection in the 
adjacent thick muscle tissue. The needle must always be in close 
touch with the bone, and is now slowly pushed forward, deposit- 
ing a few drops of fluid on its way until the ridge (Figure 93, a) 



486 LOCAL ANESTHESIA. 

is reached. About five drops of fluid are injected in this, imme- 
diate neighborhood for the purpose of anesthetizing the lingual 
nerve. The needle is now pushed very slowly forward, always 
keeping in close touch with the bone and depositing fluid on its 
way, until it is pushed in about five-eighths of an inch. It is 
important to carefully feel the way along the bony wall of the 
ramus, as the needle may have to pass over roughened and bony 
elevations, which afford attachment to the internal pterygoid 
muscle. During the injection the syringe should remain in the 
same horizontal position as heretofore outlined. Soon after the 
injection, paresthesia of one-half of the tongue on the side of 
the injection occurs, which is soon followed by anesthesia of the 
mandibular nerve. Paresthesia of the mucous membrane and 
half of the lower lip is also established. The pulps of the lower 
teeth, including the cuspid and lateral incisor and the gum tissue 
on both sides of the jaw, are anesthetized, including a part of the 
anterior floor of the mouth. The complete anesthesia of the 
two nerves also anesthetizes the whole alveolar process in this 
region. About five minutes are required for the complete anes- 
thetization of the lingual nerve, and at least fifteen minutes for 
the mandibular nerve. Braun claims that the injection is abso- 
lutely free from danger, while Romer states that danger may 
arise if the whole quantity of the solution should accidentally be 
injected into a vein. This contingency is avoided by carefully 
following the advice of Reclus, to never inject cocain solution 
unless the syringe is constantly moving. The quantity of anes- 
thetic fluid necessary for this purpose is the same as is needed 
for any other tooth — about one cubic centimeter of the solution. 
Conductive mandibular anesthesia is possible only when the 
patient can open the mouth sufficiently to allow the ready intro- 
duction of the syringe. If the tissues about the third molar are 
highly infiltrated with inflammatory exudations, local anesthesia 
is absolutely prohibited. If it is insisted upon, the resultant 
failure should not be attributed to the anesthetic, but to the 
faulty judgment of the operator. General narcosis by means 
pf nitrous oxid gas is to be preferred in such conditions, as well 
as in pronounced trismus, if a painless operation is promised. 



TECHNIQUE OF THE INJECTION. 



487 



To successfully perform conductive anesthesia on the mandibu- 
lar nerve according to Braun's method, a thorough anatomic 
knowledge of the parts involved and an expert dexterity of tech- 
nical detail, which can be mastered only by experience, are re- 
quired. As already stated, before starting the injection the pa- 
tient should be cautioned to keep perfectly quiet. In spite of 
this warning, it may happen that through an unexpected move- 




FlGURE 94. 

An Abnormal Course of the Mandibular Canal. The roots of the third molar (a) are united 
into a cone, and the nerve, artery, and vein pass through a foramen formed in the united 
roots. (Loos.) 

ment the needle will break off and become buried in the tissues. 
Unless the broken piece can be quickly grasped by the pliers, 
further attempts to find it are usually unsuccessful, and a search 
for its removal must be given up. Peckert 1 reports a few of such 
accidents occurring at the dental clinic of the Heidelberg Uni- 
versity. He claims that the broken needles were simply left 



1 Peckert: Deutsche Zahnarztliche Wochenschrift, 1908, No. 4. 



488 LOCAL ANESTHESIA. 

undisturbed, and they were borne by the tissues without further 
annoyance. He emphasizes, however, that the needles used were 
always sterile, and he attributes the absence of future disturb- 
ances to this fact. 

Certain anatomic malformations of the roots of the lower third 
molars may, on rare occasions, be the cause of very profuse ar- 
terial hemorrhage and other serious damage as a result of their 
extraction. There are, as far as the author knows, five eases on 
record in which the developing tooth inclosed in the body of its 
roots the contents of the mandibular canal — the artery, vein, and 
nerve. The extraction of a tooth possessing such malformation 
means tearing of the vessels and the nerve, causing extreme hemor- 
rhage, excruciating pain, and finally permanent insensibility of 
one-half of the lip. These are the symptoms as recorded from 
cases which occurred in the practice of Rose 1 in Munich, in 
1898, and Vorslund-Kjar 2 in Copenhagen, in 1908. 

Injection Into the Pulp (Pressure Anesthesia). 

The term "pressure anesthesia," as Ottolengui 3 relates, was 
first suggested by Wm. James Morton at a dental meeting in 
1897, and later appeared in his work on "Cataphoresis"' Its in- 
troduction into dentistry, with a description of a practical method, 
is to be credited to Ottolengui, who, in an editorial in the Items 
of Interest, 1899, made the following statement: "A certain per- 
son, or, rather, an uncertain person, is traveling through the 
West selling 'a method of painlessly removing pulps/ and charg- 
ing twenty-five dollars for 'the secret.' The secret being too good 
to keep, fraternal fellowship has led to its exposure. Pulps may 
be painlessly extirpated (so we are informed by a correspondent 
who desires that his name be not published) by carefully ob- 
serving the following instruction" — and then the Doctor describes 
a method which, in its essential principles, is practically the same 
as is utilized today. As is frequently the case with inventions 
of merit, priority is usually claimed by some one else, and so we 



1 Rose: See Witzel, Entwickelung der Kiefer, etc., 1907. 

2 Kjar: Dental Cosmos, 1908. 

3 Ottolengui: Items of Interest, 1899. 



TECHNIQUE OF THE INJECTION. 489 

are informed that George Collier demonstrated pressure anes- 
thesia at a meeting of the Texas Dental Association prior to 1898, 
and L. L. Funk claims to have received the first suggestion rela- 
tive to this method of obtunding the pulps from Professor Inger- 
soll at the American College of Dental Surgery in Chicago in 
1890. 

The following names, arranged in chronological order accord- 
ing to the year of the publication of the essays, represent the 
more important writers on this subject : William James Morton, 

A. Ottolengui, Otto Walkhoff, R. C. Young, J. A. Johnson, R. 

B. Tuller, Clyde Davis, T. S. Phillips, J. J. E. DeVries, EL A. 
Sanders, H. J. Goslee, W. D. Miller, E. T. Loeffler, George Zeder- 
baum, J. B. Buckley, W. A. Johnson, L. H. Ziegler, S. M. 
Weaver, W. Price, C. G. Meyers, George Koerbitz, Guido Fischer, 
and a host of others. 1 

By pressure anesthesia, pressure cataphoresis, pulp anesthesia, 
or contact anesthesia, as the process is variously termed, we un- 
derstand the introduction of a local anesthetizing agent in solu- 
tion by mechanical means through the dentin into the pulp or 
into the exposed pulp for the purpose of rendering this latter 
organ insensible to pain. Simple hand pressure with the finger 
or with a suitable instrument, with the hypodermic syringe or 
with the so-called high pressure syringe, is recommended for such 
purposes. 

Before describing the modus operandi of the various methods, 
the histologic structure of the dentin should be briefly recalled. 
Dentin is made up of about 72 percent inorganic salts, about 
10 percent water, and an organic matrix constituting the remain- 
ing percents. The dentin is perforated by a large number of 
tubules, radiating from the pulp cavity more or less wave-like to- 



1 The literature on pressure anesthesia has grown to very large proportions within the last 
ten years. The following references are selected from the current literature as possessing real 
merit, to which the reader may turn if he wishes further detailed information on this interesting 
subject. Brudding: Items of Interest, 1899; Ottolengui: Items of Interest, 1899; Price: Dentist's 
Magazine, 1900; Young: Dental Cosmos, 1900; Tuller: American Dental Journal, 1902; Tuller: 
Dental Review, 1902; Buckley: Dental Review, 1904; De Vries: Items of Interest, 1904; Johnson: 
Items of Interest, 1904; Ottolengui: Dental Cosmos, 1904; Sanders: Items of Interest, 1904; 
Tuller: Dental Review, 1904; Davis: Dental Summary, 1905; Goslee: International Dental Journal 
1905; Loeffler: Dental Register, 1905; Phillips: Items of Interest, 1905; Zederbaum: Dental, 
Register, 1905; Koerbitz: Zahnarztliche Rundschau, 1906; Loeffler: Dental Summary, 1906; 
Weaver: Dentist's Magazine, 1906; Ziegler: Dentist's Magazine, 1906. 



490 LOCAL ANESTHESIA. 

ward the periphery, where they branch off, forming a deltoid 
network. Komer has counted 31,500 dentinal tubules within the 
area of a square millimeter. The dentinal tubules are filled with 
the processes of the odontoblasts, and are known at present as 
Tomes' fibers. As a matter of historical fact, Joseph Linderer 
described these fibers some years prior to Tomes' publication in 
his "Handbuch der Zahnheilkunde" (1848), and speaks of them 
as "Saftfasern" (juice fibers), which carry on the metabolic 
changes in the dentin. The odontoblasts form a continuous 
cover over the pulp. The dentinal fibrils are protoplasmic in their 
nature, and normally do not carry sensation in the sense of the 
word as we understand this term as applied to a nerve fiber. 
We can cut, file, or otherwise injure the sound dentin without 
much inconvenience to the patient. When the fibers have become 
highly irritated, a mere touch on the dentin may at once call 
forth a paroxysm of pain. Pathologically, this condition is re- 
ferred to as hypersensitive dentin. Gysi 1 explains the theory 
of hypersensation of dentin on the following basis: The dentinal 
tubules contain no nerves, but an organic substance which car- 
ries on metabolic changes in the dentin. The sensitiveness of 
dentin is, therefore, not a physiologic process, and the physiologic 
sensitiveness of a tooth is conceived only by means of the nerves 
of the pulp and of the pericementum. Sensitiveness of dentin 
results from pressure, tension, or torsion on the organic substance 
of the tubules, which in turn convey the disturbance to the 
odontoblasts and then to the nerve-endings of the pulp proper. 
The contents of the tubules are aqueous in their nature, and, as 
water can not be compressed to any appreciable extent, the or- 
ganic substance confined in the tubules represents a fixed, al- 
though comparatively easily mobile, column (water filled in a 
tube one meter in length can be compressed only about 1 / 100 o 
millimeter). As there are no nerves in the dentin, the sensitive- 
ness can not be overcome by an anesthetic, unless this anesthetic 
is conveyed through this organic substance into the pulp proper. 
Substances which coagulate albumin — as phenol, silver nitrate, 
zinc chlorid, etc. — destroy the albumin molecule with which they 



1 Gysi: Deutsche Monatsschrift fur Zahnheilkunde, 1905. 



TECHNIQUE OF THE INJECTION. 491 

come in contact, but their deeper action is cut short by their 
own coagulum. If, however, drugs are applied which are non- 
coagulants and which are absorbed by the organic contents of the 
tubules, and are thus conveyed to the pulp, they may act 
as direct protoplasm poisons, depending on their individual 
pharmacologic action — destroying the vitality of the pulp com- 
pletely like arsenic trioxid, or paralyzing the nerve tissue like 
cocain. 



Methods of Anesthetizing- the Pulp. 

1. The Pulp is Wholly or Partially Exposed. — Isolate the 
tooth with the rubber dam, and clean it with water and alcohol. 
Excavate the cavity as much as possible, and, if the pulp is not 
fully exposed, wipe out the cavity with chloroform to remove 
fatty deposits from the cartilaginous layer of dentin, and de- 
hydrate with alcohol and hot air. Saturate a pledget of cotton or 
a piece of spunk with a concentrated cocain or novocain solution 
(1 novocain-suprarenin tablet dissolved in 5 drops of water), 
place it into the prepared cavity and cover it with a larger pledget 
of cotton, and then, with a piece of un vulcanized rubber or gutta- 
percha, and with a suitable burnisher or other specially devised 
instrument, apply slowly, increasing continuous pressure from 
one to three minutes. The pulp may now be exposed and tested. 
If it is still sensitive, repeat the process. Loeffler 1 states: "This 
pressure may be applied by taking a short piece of orange wood, 
fit it into the cavity as prepared, and direct the patient to bite 
down upon this with increasing force. In this way we can obtain 
a well-directed regulated force or pressure, and with less discom- 
fort to the patient and operator." Loeffler 2 has recently devised 
attachments, of different sizes and shapes, which are to be used 
with the pressure syringe. The attachment is placed into the 
cavity, over the exposure of the pulp, and cemented into place. 
After the cement has hardened sufficiently, the cocain solution 
is forced to its destination in the usual way. Loeffler claims that 



1 Loeffler: Dental Digest, 1908, p. 665. 

2 Loeffler: Dental Summary, 1906, Vol. VII. 



492 LOCAL ANESTHESIA. 

u the results obtained in a number of almost hopeless cases have 
been very gratifying, to say the least." This method requires ex- 
treme care, as in applying too much force the tooth is liable to 
be split. Miller 1 describes his method as follows : "After excavat- 
ing the cavity as far as convenient and smoothing the borders of 
it, take an impression in modeling compound, endeavoring to 
get the margins of the cavity fairly well brought out; put a few 
threads of cotton into the cavity and saturate them thoroughly 
with a 5 to 10-percent solution of cocain, cover this with a small 
bit of rubber dam, and then press the compound impression down 
upon it. We obtain thereby a perfect closure of the margin, so 
that the liquid can not escape, and one can then exert pressure 
with the thumb sufficient to press the solution into the dentin." 




Figure 95. 
Loeffler's Pressure Syringe Attachment for Anesthetizing 1 the Pulp. 

2. The Pulp is Covered With a Thick Layer of Healthy 
Dentin.- — With a very small spade drill bore through the enamel 
or direct into the exposed dentin at a most convenient place, guid- 
ing the drill in the direction of the pulp chamber. Blow out the 
chips, dehydrate with alcohol and hot air, and apply the hypo- 
dermic or high pressure syringe, provided with a special needle, 
making as nearly as possible a water-tight joint. Apply slow, 
continuous pressure for two or three minutes. With a burr the 
pulp should now be exposed, and, if still found sensitive, the 
process k to be repeated. 

Regarding the principle of pressure anesthesia, it should be re- 
membered that we can not force a liquid through healthy dentin 
by a mechanical device without injury to the tooth itself. An 



1 Miller: Dental Register, 1904, Vol. IV. 



TECHNIQUE OP THE INJECTION. 



493 



attempt to force fluids by high pressure through sound living 
dentin into a pulp will result in failure. Walkhoff has tried to 
force colored solutions into freshly extracted teeth by applying 
six atmospheres pressure for half an hour without success. If a 
cocain solution is held in close contact with the protoplasmic 
fibers of the dentin, the absorption of cocain takes place in ac- 
cordance with the laws of osmosis. The imbibition of the anes- 




FlGURE 96. 

An Aqueous Solution of Eosin Forced Through Dentin with a Jewett-Willcox Syringe. 
Time, one and one-half minutes. The pulp is stained. (Miller.) 



thetic is enhanced by employing a physiologic salt solution as a 
vehicle. Living protoplasm, however, reacts unfavorably against 
the ready absorption of substances by osmosis for two reasons: 
First, as Graham has shown, the albumin molecule is relatively 
large and not easily diffusible, and, second, as an integral part 
of its life it possesses " vital" resistance toward foreign bodies. 



494 LOCAL ANESTHESIA. 

These biologic facts, as stated by Walkhoff, 1 describe in a preg- 
nant manner some of the most important physiologic functions 
of the odontoblasts. The accuracy of this dictum is easily dem- 
onstrated by the fact that it is almost impossible to stain living 
tissue, while dead tissue is at once penetrated by a suitable stain- 
ing solution. Contact anesthesia is possible only when the medica- 
ment is placed on dentin in the form of a solution, and conse- 
quently dehydration of the protoplasm increases the endosmosis 
of the anesthetic solution markedly. 

When we apply the same pressure anesthesia on carious dentin, 
the above statements do not hold good. We are able to press 
fluids quite readily through carious dentin. We must bear in 
mind that such dentin has been largely deprived of its inorganic 
salts, leaving an elastic, spongy matrix in position. The carti- 
laginous dentin should be suitably prepared prior to the intro- 
duction of the anesthetic solution — that is, the fatty deposits should 
be removed with chloroform, and the moisture dehydrated with 
alcohol and the hot air blast. If the anesthetic fluid is now con- 
fined under a suitable water-tight cover, the pressure applied by 
the finger or with an instrument is quite sufficient to obtain the 
desired result. Aqueous eosin solutions may be forced through 
such dentin in less than two minutes, and even thick layers of 
dentin may be readily penetrated by such colored solutions by 
slightly increasing and prolonging the pressure. It should be 
borne in mind that these experiments, if conducted with teeth out 
of the mouth, do not at all represent the conditions as found in 
teeth in their normal anatomic surroundings. 

In teeth not fully calcified and in so-called "soft" teeth, pressure 
anesthesia is more readily obtained, w T hile, according to Zeder- 
baum, 2 the process fails in teeth of old persons, teeth of inveterate 
tobacco chewers, worn, abraded, and eroded teeth with extensive 
secondary calcific deposits, teeth whose pulp canals are obstructed 
by pulp nodules, teeth with metallic oxids in tubules, teeth with 
leaky old fillings, badly calcified teeth, mainly all from one and 
the same cause — namely, clogged tubules. In most cases no 



1 Walkhoff: Das Sensibile Dentin, 1899. 

2 Zederbaum: Dental Register, 1904, p. 80- 



TECHNIQUE OF THE INJECTION. 



495 



amount of persistent pressure will prove successful. The recent 
classic researches of Reich 1 on the formation of irregular dentin 
have amply demonstrated that secondary deposits of dentin are 
much more frequently present in the pulp chamber than have 
hitherto been supposed. The histologic structure of secondary 






mm 




J2. 





i 






<> y 



pp^ 



Figure 97. 



IP 



Section Through the Root of a Molar. Shows irregular (secondary) dentin. (Reich.) 
C, cementum; D, D, normal dentin; P, pulp; J D, irregular dentin in two layers (<x, 6). 

dentin, as observed under the microscope, frequently shows an 
irregular mass of twisted tubules, which have no connection with 
the odontoblasts. Such dentin, as well as the presence of pulp 
nodules, mechanically bars the forcible introduction of fluids into 
the pulp. 



1 Reich: Das Irregulare Dentin, 1907. 



496 



LOCAL ANESTHESIA. 



According to Hertwig 1 the protoplasm of the cell primarily 
transfers irritation, and, secondly, transmits absorbed materials, 
and therefore the anesthetic solution has to pass through the en- 
tire length of the dentinal fiber before the nerve tissue of the pulp 
proper is reached. Consequently a certain period of time is re- 
quired before the physiologic effect of the anesthetic is manifested, 
and this period of latency is dependent on the thickness of the in- 
termediate layer of dentin or bone. The successful anesthetization 
of the pulp depends largely on this most important factor of allow- 
ing sufficient time for the proper migration and action of the drug. 

Immediate root filling following the extirpation of the pulp by 
cocain anesthesia is not to be recommended. According to Buck- 



FlGURE 98. 

Points for Pressure Obtunding Syringe, a, an ordinary dental hypodermic needle is ground 
off at its point of reinforcement; b, specially shaped point made to fit the drill hole; c, specially 
shaped point with attachment for rubber washer. 



ley, 2 among the many good reasons why a root canal should not 
be filled at this sitting, the following are mentioned : The tissues 
above the foramen may have become anesthetized, and they do not 
act as a guide when the root is to be thoroughly filled; the tearing 
of the pulp from its connections at the apex produces more or less 
severe irritation, which can be readjusted only by time; the root 
filling coming in contact therewith will only further irritate these 
tissues ; and consequently hemorrhage and the formation of a clot 
in the apical area may also cause future severe irritation if the root 
is filled at the same sitting. A bland antiseptic should be inserted 



1 Hertwig: The Cell, 1903. 

2 Buckley: Johnson's Text Book of Operative Dentistry, 1908. 



TECHNIQUE OP THE INJECTION. 



497 



in the root canal for a day or two, or until the much damaged 
tissues about the apex of the tooth have regained their normal 
equilibrium. 

Within recent years a number of complicated syringes, variously 
known as high pressure syringes and obtunders, have been advo- 
cated for the purpose of forcing anesthetic solutions through tooth 
substance by intense pressure. As we have stated, this conception 
of pressure anesthesia is erroneous. Close contact of the anes- 
thetizing fluid with the dentinal fibers, plus the necessary time for 
conveying the absorbed anesthetic to the nerve endings, explains 
the phenomenon very plausibly. A strong metal syringe, provided 




Figure 99. 
Weaver High Pressure Obtunding Syringe. 



with a specially prepared needle to make a water-tight joint as near 
as possible, is all that is required. Those who prefer a special 
high pressure syringe for such purposes may purchase any one of 
the many devices that will best suit their fancy. The Weaver ob- 
tunder or the Jewett-Willcox syringe are much lauded for such 
purposes. 

Any of the various methods for anesthetizing a tooth for the 
purpose of its extraction, as outlined under "The Technique of 
the Injection," may be used for anesthetizing the pulp. Under 
certain conditions such procedures may be preferred to the various 
methods of pressure anesthesia. 



498 LOCAL ANESTHESIA. 

Treatment of Hypersensitive Dentin. 

Normal dentin has no sensation. The prolongations of the 
odontoblasts — the dentinal fibrils — when irritated directly or in- 
directly, may become extremely hypersensitive. This condition 
lasts as long as the pulp remains in a state of irritation. The 
remedies that are employed for the purpose of relieving the irrita- 
tion may be conveniently divided as follows : 

1. General sedatives and anesthetics. 

2. Local sedatives and anesthetics. 

3. Caustics. 

The general sedatives and anesthetics are administered in- 
ternally with the object of reducing the sensibility of the entire 
nervous system. Such drugs are opium, chloral hydrate, the 
bromids, and the general anesthetics. The local sedatives and anes- 
thetics are applied on the dentin or on the tissues surrounding the 
tooth. The object of the latter method is to reach the nerves at the 
apical end of the tooth, and the drugs used for this purpose are 
cocain and its substitutes, certain essential oils, and the refrigerant 
agents. The caustics are applied locally, and destroy the dentinal 
fibrils progressively. Most caustics are more or less self-limiting, 
and must be brought into intimate contact with the fibrils in order 
to destroy them. Arsenic trioxid, which, correctly speaking, is not 
a caustic, is not self-limiting in its action, and when applied on 
dentin always destroys the pulp via the dentinal fibrils. At pres- 
ent it is not used for the purpose of reducing hypersensitiveness 
of the teeth. 

Without entering into a discussion of the value of the various 
methods employed, we wish to merely call attention to the local 
anesthetization of the pulp, either through the dentinal fibrils or 
by way of reaching the nerves at the apex of the individual 
tooth. To desensitize the dentin, any of the various methods that 
have been discussed under "The Technique of the Injection," in- 
cluding pressure anesthesia, may be successfully employed. It 
should be remembered that the tooth pulp is practically a transi- 
tory organ, which is subject to many changes during its life. In 
the young the pulp mass is large and very vascular, while in the 
old it is usually atrophied and spudded with pulp stones or lime 



TECHNIQUE OF THE INJECTION. 499 

concretions of various shapes. It should be kept in mind that 
only a few drops of a 2-percent novocain-adrenalin solution are 
required to completely anesthetize the pulp, provided sufficient 
time be allowed for the action of the anesthetic, and the anesthesia 
lasts from forty to sixty minutes. For anatomic reasons the best 
results are obtained in the anterior teeth. The objections made 
to this method that the pulp may die, or otherwise become injured 
by the anesthetic, are unfounded, provided the minimum quantity 
of the anesthetic solution is used. We have been able to satisfac- 
torily demonstrate by tests made with the electric current, accord- 
ing to Schroder's suggestion, that the pulp always regained its 
normal activity after it had been anesthetized for the above pur- 
pose. Recently exhaustive tests have been made on animals by 
Euler, of the Dental School of the University of Heidelberg, with 
a view to establishing the possibility of producing death of the 
tooth pulp by injecting novocain-adrenalin according to the above 
method. In no case did he succeed in permanently injuring the 
pulp even by employing relatively large quantities of the above 
solution. Accidentally cutting into the pulp in preparing the 
cavity may be considered a source of danger, as the normal sensa- 
tion of the pulp, which acts as a warning guide when too closely 
encroached upon, is temporarily abolished, and this fact may mis- 
lead the operator when excavating a cavity. Careful observation 
of the field of operation will cause a halt when the danger line is 
approached. 

Some years ago potassocoin, a solution of cocain in alcohol and 
ether, with the addition of a small quantity of caustic potash, and 
vapocain, "a local obtundent containing 15 percent cocain hydro- 
chlorid in ethereal solution," were freely discussed in dental litera- 
ture as useful remedies for the treatment of hypersensitive dentin. 
Both solutions are active only through their cocain component. 
The latter is materially interfered with in its ready absorption by 
the alcohol or ether solvent. Potassocoin apparently disappeared 
from the market, while vapocain is seemingly still in use. When 
applied to dentin, the ether has to be evaporated before the cocain 
can act on the dentinal fibers, and has to be redissolved by the 
aqueous contents of the tubules in order to act. "Vapocain is found 



500 LOCAL ANESTHESIA, 

in practice to possess great penetrating power, and this action 
seems to be due to the fact that the heat of the mouth vaporizes 
a portion of the ether, driving the natural fluid of the tooth out 
of the tubules, thus securing a rapid distribution of the remaining 
portion throughout the tooth structure. From this portion the 
ether is dissipated, leaving the cocain salt distributed in minute 
subdivisions throughout the tubules. The cocain is then redis- 
solved by the natural fluid of the tooth, securing a rapid and 
effective anesthesia." Under pressure anesthesia we have dis- 
cussed the fallacy of "driving cocain into the tubules of a living 
tooth." 

Some years ago cataphoresis was much lauded for the purpose 
of desensitizing dentin. The principle of cataphoresis — electric 
endosmosis — consists in carrying a drug, which must be an electro- 
lyte, by means of the electric current into the tissues. The 
medicament is decomposed by the current — electrolysis — into ions. 
The ion, which is deposited on the positive pole, is known as the 
anion, and the deposit on the negative pole is referred to as the 
kation. For the above purposes cocain is usually employed. The 
complicated apparatus and the many difficulties that are encoun- 
tered in the application of cataphoresis do not justify the results 
obtained, as they are often unsatisfactory, and the method has been 
generally abandoned. From an historical point of view it is inter- 
esting to observe that Reuss, 1 of Moscow, wrote as early as 1809 
on the subject of electric endosmosis. He was followed in later 
years by a number of other investigators, especially by Wiedemann 
(1856), Du Bois-Reymond (1860), Clemens (1860), and Beer 
(1869). "When cataphoresis was introduced into dentistry in 
1895 it seems that the past literature on the subject had escaped 
the notice of the majority of the writers on this subject, and many 
of the known facts had to be "rediscovered." 

Insufflation Anesthesia of the Upper Anterior Teeth. 

Shortly after the introduction of cocain for anesthetic purposes 
(1884), Petsch, of Berlin, incidentally discovered that anesthetiza- 

r 

1 Reuss: Notice sur un Nouvel Effect de 1' Electricity Galvanique. Memoirs de la Societe 
Imperiale des Naturalistes a Moscou, Vol. II. 



TECHNIQUE OF THE INJECTION. 501 

tion of the lower nostrils with a cocain solution produced also a 
more or less pronounced anesthesia of the upper anterior teeth. 
After some experimental work carried on in this direction he pub- 
lished his observations, and called this new procedure "The In- 
sufflation Method of Local Anesthesia." At this time no one 
seemed to take any notice of this new method, and it was soon 
forgotten. In 1907 Lederer, of Prague, and Escat, 1 of Toulouse, 
independently of each other, described anew this method of endo- 
nasally producing anesthesia of the upper front teeth. Very 
recently (1908) M. de Terra, 2 of Zurich, published a detailed 
account of this procedure. De Terra's technique is very simple. 
In accordance with the anatomical relations, the right nostril is 
selected for the right upper teeth, and, vice versa, the left nostril 
for the left side. The head of the patient is slightly bent for- 
ward, and with a nose speculum the nostril is enlarged, thus ex- 
posing the nasal septum on the one side and the lateral cartilage 
on the other side. With an absorbent tampon, fastened on a 
metallic probe and dipped into a "cocain-adrenalin solution, the 
tissues are slightly massaged by moving the tampon to and fro. 
A slight tingling and disagreeable sensation is produced for a 
few minutes, accompanied by free lachrimation. In from two to 
three minutes the anesthesia of the mucous membrane of the 
nose is completed. A cotton ball tied to a short string is now 
saturated with the anesthetic solution and placed in the lower 
nostril. During the time the tampon remains in the nose the pa- 
tient should assume a sitting posture to avoid the possible escape 
of some of the liquid into the posterior nares." Escat has studied 
with the utmost care the effects of nasal anesthesia on the teeth, 
and summarizes the results of his observations as follows: 

1. In thirty-six cases a complete anesthesia was obtained of 
the central incisor and of the cuspid on the side corresponding 
to that of the nasal fossa subjected to the action of the anesthetic ; 
also an incomplete anesthesia of the first bicuspid adjoining the 
anesthetized cuspid, and of the lateral incisor on the opposite side. 

2. In eight cases the anesthetized area included, in addition to 



1 Escat: Dental Register, 1907, p. 306. 

2 De Terra: Correspondenzblatt fur Zahnarzte, 1908, p. 244. 



502 LOCAL ANESTHESIA. 

the incisors and cuspid on the corresponding side of the anes- 
thetized nasal fossa, the incisors and cuspid on the opposite side. 

3. In one case the anesthesia of the incisors and cuspid on the 
opposite side of the anesthetized nasal fossa was complete, while 
that of the incisors and cuspid on the corresponding side was in- 
complete. 

In order to explain this form of anesthesia, Escat offers the 
following plausible explanation: 

1. The infiltration of the floor of the nose, the penetration 
through the mucous lining and the thin lamina of bone, and the 
absorption by the lymphatics carry the anesthetic solution to 
the nerves supplying the teeth. 

2. The cocain is taken up directly by these nerves, which fur- 
nish branches to the incisors and to the canine teeth. In order 
to explain the anatomic mechanism of this form of anesthesia, 
Clermont, of Toulouse, undertook the study of a large number of 
specimens. He has found that the anterior superior dental 
branch of the superior maxillary nerve, which supplies the in- 
cisors and cuspids, and gives off a nasal branch which supplies 
the mucous membrane of the anterior portion of the nasal cavity, 
is not inclosed deeply in the substance of the maxilla, but that, on 
the contrary, it runs in close proximity to the floor of the nasal 
cavity. In twenty-nine specimens of a series of fifty-five he 
found the canal normally formed, but with an extremely thin 
upper lamina — so thin indeed that it was transparent and easily 
pierced — and in thirteen cases the canal was really a groove, as 
it lacked the upper wall, or lamina. This intimate relationship 
of the anterior superior dental nerve with the nasal mucous mem- 
brane explains satisfactorily, the author says, the anesthesia of the 
upper teeth following anterior intranasal anesthesia, for in 47 
percent of the cases the cocain tampon is separated from the 
anterior superior dental branch by only the mucous membrane, 
and in 53 percent of the cases the tampon is separated from the 
nerve by a very thin lamina of the osseous tissue, through which, 
it is easy to conceive, the cocain readily reaches the nerve. 

Insufflation anesthesia is not always reliable. Many patients, 
especially anemic and extremely nervous individuals, are highly 



TECHNIQUE OF THE INJECTION. 503 

reactive to cocainization of the nose, and frequently complain 
about a feeling of general malaise, lasting for hours after the 
anesthetization. 



Local Anesthesia for Operations About the Mouth, 
Exclusive of the Extraction of Teeth. 

In operating about the mouth for an abscess, a cystic or a solid 
tumor of the approximate size of a large walnut, a malposed tooth, 
or for any other purpose, the rhomboid infiltration according to 
Hackenbruch 1 affords the simplest methods of producing a most 




Figure 100. 
Anesthetizing a Small Tumor by Rhomboid Injection. (Hackenbruch.) 

satisfactory anesthesia. After previously cleansing the field of 
operation with an antiseptic solution, a very small drop of phenol 
is placed at a and b (Figure 100) to superficially obtund the point 
of puncture. The needle is quickly thrust through the mucosa at 
a, and at once slow pressure is exerted on the piston, moving the 
needle steadily along the external line of the tumor. The needle 
is now partially withdrawn, without, however, leaving the origi- 
nal puncture, and a second injection or as many as may be 
needed are made in opposite directions. This maneuver is now 
repeated at b, and thus a circumscribed infiltration of the whole 
tumor is obtained. If the tumor, etc., is very large, additional 



1 Hackenbruch: Schmerzverhiitung in der Chirurgie, 1906. 



504 LOCAL ANESTHESIA. 

punctures and injections may be made as outlined in the schematic 
drawing. After ten to fifteen minutes' waiting the extirpation 
of the tumor may be begun. For injecting the soft tissues other 
than the gum, a 1-percent novocain-adrenalin solution — one tablet 
dissolved in two cubic centimeters of water — is quite sufficient. 

The anesthetization of the soft and hard palate is comparatively 
easily accomplished. The injection on the hard palate is started 
at the gingival edge of the alveolar periosteum on both sides of 
the jaw toward the median line. As this gum tissue is extremely 
dense, great force is required for a complete infiltration in this 
region, and only small quantities of the solution are required. 
The soft palate is easily infiltrated by inserting the curved needle 
posteriorly of the third molar. 

Small tumors and cysts on the tongue or the floor of the mouth 
are best anesthetized bv the rhomboid infiltration of Hackenbruch. 




Figure 101. 
Section Through an Anesthetized Tumor, a, b, the zone of infiltration. (Hackenbruch.) 

For the complete extirpation of a ranula, the injection is made 
into the cyst wall near the periphery, after which the cyst is slit 
open and a small quantity of the anesthetic solution is injected 
into the inner surface of the cyst. Large cysts, tumors, and major 
operations on the tongue require the anesthetization of both 
lingual nerves, as described on page 484. In injecting and operat- 
ing on the floor of the mouth, the index finger of the left hand 
should be placed on its external surface as a guide to the needle 
or the knife. 

The opening of the maxillary sinus (antrum of Highmore) 
from the oral cavity, whether by the Cowper-Drake operation — 
through the alveolus of an extracted tooth — or by the Lamorier- 
Desault modification — through the canine fossa — is successfully 
accomplished under local anesthesia. If the sinus is opened 
through an alveolus, the technique of the injection is prac- 



SIDE AND AFTER EFFECTS OF LOCAL ANESTHETICS. 505 

tically the same as used for the extraction of a tooth. If the 
perforation is to be made through the anterior wall of the sinus, 
the infiltration of the tissues is made as follows: The corner of 
the mouth is lifted upward and backward by means of a cheek 
retractor, the injection is started by inserting the needle hori- 
zontally over the cuspid tooth near the gum fold and in close con- 
tact with the bone, and the needle is moved posteriorly in various 
directions so as to infiltrate as large a field as possible. Two 
to three cubic centimeters of the anesthetic solution, prepared 
by dissolving two novocain-suprarenin tablets in three cubic centi- 
meters of water, are necessary. After ten minutes' waiting a 
large semi-circular cut is made, reaching from the canine emi- 
nence to the first molar; the flap, including the periosteum, is 
lifted up, and the extremely thin bone is now penetrated with 
a suitable drill. The sensitive mucous lining of the sinus is 
usually sufficiently anesthetized by the penetration of the fluid 
through the thin bone. We can recommend this method of 
opening the antrum of Highmore as the most satisfactory pro- 
cedure from the dental surgeon's standpoint. 

SIDE AND AFTER EFFECTS OF LOCAL ANES- 
THETICS AND THEIR RELATION TO 
THE PENAL CODE. 

Since cocain and its many substitutes, employed for the pur- 
pose of producing local anesthesia, have become an important 
adjunct to the armamentarium of a routine practice, quite a 
number of cases are on record in which the administration of 
these chemicals has caused serious untoward effects, which re- 
sulted in bringing the respective practitioners in conflict with the 
law. From a legal point of view these side and after effects may 
be considered as resulting in death of the patient, or producing 
intense psychic disturbances. Deaths from cocain, administered 
hypodermically, were comparatively frequent in the earlier days 
of its history, and may be attributed to two specific causes — first, 
to an impure product, and, second, to a too large dose. 

Cocain intoxication usually manifests itself in three definite 



506 LOCAL ANESTHESIA. 

ways. The first stage is characterized by intense psychic excite 
ment; violent incoherent gesticulations are predominant, which 
are accompanied by muscular tremors and garrulity ; the pulse is 
rapid and the respiration is very much increased ; frequently pro- 
nounced depressing sensations are noticed; very slowly the patient 
will become quiet again. The second form of intoxication is rela- 
tively seldom met with; clonic and tonic spasms of groups of 
muscles, especially of the arms and limbs, are predominant; oc- 
casionally complete spasms may occur; after diminishing of the 
disturbance, the patient falls into a deep sleep. The third and 
most common form of cocain intoxication is the so-called cocain 
collapse: the patient faints; the skin is cold and clammy; the 
pulse is low, very rapid, and sometimes irregular; the respiration 
is much increased, being laborious in the beginning and later on 
weaker and irregular, resembling what is known as the Cheyne- 
Stokes respiration ; there is a pronounced feeling of fear from suf- 
focation and heart weakness; the patient collapses into a deep 
coma, and death results from cessation of respiration. 

Lewin 1 cites some very interesting factors concerning the side 
action of cocain. He states that neither the dose, the point of ap- 
plication, nor the individuality plays an important part in the un- 
toward effects of cocain. These disturbances may occur either 
within a few minutes or even months after the administration of 
the poison. Cases are on record which show that patients have 
suffered for several weeks, or even for months, from its side effects. 
Women who have received cocain may display erotic conditions, 
with or without disturbance of consciousness. This fact makes it 
apparent that it is advisable to have a third person present when 
cocain is to be administered by the practitioner. In one instance 
the injection of cocain produced voluptuous emotions in a man, 
which resulted in ejaculation, and thus became the primary cause 
of his becoming a cocain habitue. The disturbances of the central 
nervous system manifest themselves in more or less intense excite- 
ment, either temporarily or lasting for hours, or even weeks. 
The patient is usually very garrulous or hilarious; he will boast 
of his great corporal strength and his immense mental faculties; 



1 Lewin: Nebenwirkungen der Arzneimittel, 1899. 



SIDE AND AFTER EFFECTS OF LOCAL ANESTHESIA 507 

he may remember facts which occurred twenty or thirty years 
ago, or he may talk in a quivering voice, or show signs of slight 
intoxication ; often he runs to and fro, moving his arms or his 
body violently, or gives signs of hallucinations; occasionally the 
excitement may become so intense as to resemble mania. The 
paroxysm of intense excitement is usually followed by a more or 
less lasting depression, which often reaches a melancholic or 
apathetic state. 

Intense psychic disturbances from average doses of cocain and 
its substitutes are comparatively rare at present, but nevertheless 
the recorded cases that have found their final settlement in courts 
of law are of sufficient importance to the general practitioner to 
warrant special mention. While it is an established fact that 
after general narcosis — whether the anesthetic be chloroform, 
ether, ethyl chlorid, ethyl bromid, or nitrous oxid gas — orotic 
dreams and sexual excitement have been frequently observed in 
men, and more especially in women, it is also important to re- 
member that such disturbances do occur after the injection of local 
anesthetics. Cocain and its substitutes do not produce general 
narcosis, but they are known to have brought about a form of 
semi-conscious sleep, which apparently resembles hypnotic sleep. 
Fischer 1 reports a case of this nature as follows: 

A lady about 36 years of age, well built and of sound health, 
wished to have the abscessed roots of a lower molar extracted. 
Fischer injected 3 cubic centimeters of a 2-percent novocain- 
thymol solution, to which he had added at the time of the injec- 
tion 3 drops of the new synthetic suprarenin solution (Hochst), 
1 :1000. The injection, as in all patients of good constitution, was 
completed without pain. The time necessary for the diffusion of 
the liquid through the lower jaw bone was approximately calcu- 
lated at fifteen minutes. To make use of the intervening time, 
Fischer excavated two cavities on the same side of the mouth in 
the upper jaw. About one minute after the injection the patient 
noticed a complete anesthesia of the entire half of the left lower 
jaw; after about five minutes she was unable to feel the touch 
of the drinking glass on the lips on the affected side, and at about 



1 Fischer: Deutsche Zahnarztliche Wochenschrift, 1908, p. 545. 



508 LOCAL ANESTHESIA. 

this time a slight increase in the pulse rate, lasting from one to 
three minutes, was perceptible. The patient fell into a half 
slumber, and she was barely able to open the mouth sufficiently 
to allow the preparation of the cavities in the upper teeth. The 
pulse and the respiration were soon normal again, and the patient 
had the appearance of a peaceful sleeper. She opened -and closed 
her mouth at the doctor's command and followed instructions, 
without, however, opening her eyes. The cavities were excavated 
without apparently feeling any pain, although the pulps were 
nearly exposed. About twenty minutes may have elapsed, and the 
two badly decayed root remnants were extracted. The patient 
awoke with a start, opened her eyes, and at the doctor's command 
washed out her mouth. She was now perfectly normal, and stated 
that a sudden pain from pressure awakened her. The anesthesia 
on the left side of the mouth was still persistent, The patient 
claimed that she always had been perfectly sound and healthy, 
and that she reacted very quickly and strongly to medicines. She 
had no knowledge of what happened during the sleep, and she 
was glad to know that the teeth were filled and the roots ex- 
tracted. 

Another interesting case that illustrates very forcibly the pro- 
nounced psychic effects of local anesthetics, resulting in this in- 
stance in grave charges against the attending dental surgeon, oc- 
curred in Korner's 1 dental clinic at the University of Halle (Ger- 
many) . The wife of a school teacher presented herself at the in- 
firmary to have a root of a bicuspid extracted. The tissues were lo- 
cally anesthetized with the ethyl chlorid spray, and the root was 
extracted by a student in the presence of the instructor. Not the 
slightest indication of a general narcosis, as sometimes occurs by 
inhaling the vapors of ethyl chlorid when sprayed on tissues in the 
mouth, was noticed. Immediately after the tooth was removed 
the woman left the operating room, being instructed to return in 
a week's time to have her mouth inspected. A week later the 
woman appeared before the chief of police, and in the presence of 
a physician made the statement that she had been raped by both 
the instructor and the student at a dental institution. The recall- 



1 Korner: Deutsche Monatsschrift fur Zahnheilkunde, 1904, p. 283. 



SIDE AND AFTER EFFECTS OF LOCAL ANESTHETICS. 509 

ing of this supposed episode occurred to her a week after the opera- 
tion at the very moment when she re-entered the dental infirmary. 
Korner at once demanded a medical examination of the woman, 
and the neurologists diagnosed an acute psychotic disturbance, 
which resulted in committing her to an insane asylum, from 
which, after months of treatment, she was discharged. 

Hallucinations produced under cocain influence may result in 
definite lasting impressions regarding certain persons or circum- 
stances. The following case furnishes a definite illustration : x 

A young lady claimed that she had been grossly insulted in a 
dental institute in Vienna, and that she recognized in the person 
of Doctor X, the supervisor of the clinic, her assailant. Her testi- 
mony consisted in one stereotyped answer to all questions, "It is 
he." On this testimony, and in spite of the Doctor's plea that 
he had never seen the person before, the Doctor was sentenced to 
serve eight days in jail. The defense appealed the case for re- 
vision, and Doctor X introduced a few snapshot pictures that were 
made with a camera by some friends while they and he were on 
a visit some miles away from Vienna on the same day and at the 
same hour which the plaintiff had specified in her claim. On 
being confronted with the pictures, the woman again pointed to 
the Doctor's figure in the picture and exclaimed, "It is he." The 
Court thereupon dismissed the case. 

Cocain intoxication, when combined with hysteria, may in some 
instance place the operator in an extremely embarrassing posi- 
tion, as illustrated in the following case: 2 

A miss had a tooth extracted at a dental clinic, a local anesthetic 
being used. She showed signs of slight cocain intoxication and 
hysteric disturbances, but soon rallied and went home. Shortly 
afterward the assistant of the clinic, who was present at the opera- 
tion, but whom the lady did not know even by name, received 
love letters from her. They remained unanswered, and three days 
later the lady killed herself by shooting after she had written to 
the assistant that she would do so unless she received an answer 
from him. 



1 Ritter: Berliner Zahnarztliche Halbmonatsschrift, 1908, Vol. XVIII, 

2 Ritter: Rechte, Pflichten und Kunstfehler in der Zahnheilkunde, 1903. 



510 LOCAL ANESTHESIA. 

To illustrate the temporary paralyzing effect of cocain intoxica- 
tion, the following case will serve as an example. 1 

On the 29th day of August, 1888, a woman went into the office 
of Doctor E. P. Maloney, of New Orleans, to have a tooth ex- 
tracted. In order to extract it without pain, the doctor injected 
cocain hypodermically, in accordance with the demand. She 
stated that she had had the drug administered previously, and 
that she was keenly sensible to its effects, the last operation having 
rendered her ill for nearly three 'weeks. With these facts as a 
guide, Doctor Maloney proceeded to inject a small quantity of a 
weak solution — 2-percent — into the gums. The lady demanded 
that more of the drug be used, as the gums still ached, and when 
the doctor, demurred she left the chair without the tooth having 
been extracted. At the time she left she felt ill, and a moment 
later, after she had passed out of the office into the hall, the Doctor 
was startled at hearing a piercing scream coming from that direc- 
tion, and, hastily going to the spot, found that the lady had fallen 
unconscious. She remained in that condition for several hours, 
and ten thousand dollars damages were demanded for the injuries 
sustained from the injection of cocain. The case was thrown out 
of court on a technical error. 

The defense of a charge of assault claimed to have been com- 
mitted while the patient was under the influence of local anes- 
thesia requires the careful consideration of certain important fac- 
tors. Judge and jury are seldom confronted with cases of this 
nature, and they are only too apt to place the guilt on the dentist, 
especially if he is a young practitioner and is unable to bring wit- 
nesses for his defense. If the plaintiff is a young miss, the 
chances are still worse for the practitioner. 

From a medical point of view the strong plea of the defense 
should center about the following facts: 2 

1. Cocain and most likely its alkaloidal and synthetic substi- 
tutes employed as local anesthetics are known to produce more or 
less intense side and after effects, which may result in severe 
psychic disturbances. 



1 Renfuss: Dental Jurisprudence, 1892, p. 65. 

2 Dorn: Odontologische Blatter, 1906, p. 223. 



SIDE AND AFTER EFFECTS OF LOCAL ANESTHETICS. 511 

2. The local use of cocain and its substitutes do not produce 
genera] narcosis. They are known to have induced sexual excite- 
ment and erotic disturbances, which are prone to appear more 
often in woman than in man. 

3. Local anesthesia, as produced in the mouth by ethyl chlorid 
or similar hydrocarbons, may also produce light forms of general 
anesthesia if some of the vapor is inhaled. 

Frequently a Avell-prepared brief, setting forth the side and 
after effects of local anesthetics, including an index of the litera- 
ture on the subject, and placed in the hands of the presiding 
judge, may materially assist in bringing about a broader concep- 
tion of the case under consideration. 



APPENDIX. 



DIAGNOSIS OF DISEASES OF THE PULP BY 
THE ELECTRIC CURRENT. 

When a weak electric current is passed through the body of a 
vital tooth, a more or less pronounced reaction is produced, which 
is an expression of the vitality of its pulp. By carefully gauging 
the current, the resulting irritation expressed as pain becomes 
a most valuable diagnostic agent in determining the stage of 
vitality of the pulp. The correct diagnosis of a normal, a dis- 
eased, or a dead pulp is always a matter of great difficulty, and 
this difficulty is increased if the tooth under consideration does 
not present any visible signs of derangement. Various physical 
tests — color, translucency, conductivity of temperature, percus- 
sion sound, etc. — are at present in vogue, either alone or in their 
combined forms. The diagnostic value of these various tests is, 
to some extent at least, helpful in arriving at some possible diag- 
nosis, but these tests furnish no positive proof of the condition 
of the pulp. The transparency of the tooth may not be altered 
perceptibly by the death of the pulp. The discoloration of a 
tooth, on the other hand, may be brought about by the various 
filling materials themselves, by recurrent caries under the rilling, 
or by leakage of the filling. The transillumination of a tooth by 
means of the electric mouth lamp furnishes a fairly reliable 
shadow picture of a healthy pulp; the picture is diffused or dull 
when a dead pulp is present. Owing to the natural size of the 
teeth, the anterior teeth are more easily transilluminated. In 
the bicuspids, and especially in the molars, the thick body of the 
tooth crowns prevents ready transillumination, and as a conse- 
quence the diagnostic value of the light rays is much diminished. 
Transillumination of the oral structures should always be con- 
ducted in a darkened room, as it will materially assist in bring- 
ing out the shadow pictures much clearer than in the presence 

513 



514 APPENDIX, 

of light. The heat test is also useful, but by no means absolute. 
Usually this test is made by placing a pellet of heated gutta- 
percha or some similar material on the surface of the sus- 
pected tooth. A tooth with a dead pulp does not respond in the 
same manner as a tooth with a normal, living pulp. The thick- 
ness of the tooth structure and the presence of the various filling 
materials may, according to their nature, increase or decrease 
the conductivity of heat. An existing pulpitis may sometimes 
be fairly well diagnosed by the use of water of various tempera- 
tures. Walkhoff makes the statement that a normal pulp will 
not react between 68° and 120° F. (20° and 50° C). Pain pro- 
duced by water below 98° F. (37° C.) indicates inflammation, 
while pain produced above this temperature indicates the forma- 
tion of pus. Tapping the tooth with a steel instrument is helpful. 
Percussion is best performed by striking the tooth with the butt 
end of an excavator, employing a short, sharp blow. The peculiar 
dullness of the resulting sound from a tooth with a dead pulp, as 
compared with that from a normal tooth, can be distinctly dis- 
cerned by the trained ear. The dullness of the sound is probably 
caused by inflammatory changes of the peridental membrane 
resulting from the disturbances of the products from the dead 
pulp or from external causes. The infiltration and the thicken- 
ing of the fibers change the relationship of the tooth to the 
alveolar bone, and consequently the sound waves produced by 
the tapping have not that full, clear tone which we perceive from 
a similar percussion of a tooth with a normal pulp and healthy 
pericementum. Within recent years the electric current has been 
advocated as a means of diagnosing diseases of the pulp. The 
results obtained by this process are very gratifying, and its use 
for such purposes deserves to be highly recommended. 

History. — Dr. John S. Marshall, 1 in a paper entitled, "Elec- 
tricity as a Therapeutic Agent in the Treatment of Hyperemia 
and Congestion of the Pulp and the Peridental Membrane," makes 
the following statement: "As a means of diagnosis in obscure 
cases of the vitality or nonvitality of the dental pulp, I know of 
nothing so sure to demonstrate to a positive certainty these condi- 
tions as the electrical currents, both the galvanic and the faradic. 



1 Marshall: Dental Cosmos, 1891, p. 973. 



DIAGNOSIS OF PULP DISEASES. 515 

In the more obscure eases, however, the faradic is superior to the 
galvanic, for if there is the slightest vitality remaining in the pulp, 
it will demonstrate it instantly by causing a response in the tooth." 
In 1896 Woodward 1 demonstrated the following: "If a few cells 
of a cataphoric apparatus are in action, and the positive electrode 
be applied to the dentin or a metallic filling in a vital tooth, while 
the negative pole is at the cheek or wrist of the patient, a distinct 
sensation should be felt, while in case of a dead pulp there will be 
no response ; usually even a small filling will transmit a distinct 
shock in a vital tooth, which is absent in a devitalized tooth. A 
mild interrupted current has also been used for the test." 

Woodward's recommendation of testing the pulp by the electric 
current has never received the recognition by the profession which 
it justly deserves. This is probably due to the fact that his state- 
ments made before the Philadelphia Academy of Stomatology 
were never published in the current literature. 2 In 1902 Fuyt, 3 
of Utrecht, published his researches "about the use of weak inter- 
rupted currents for the purpose of locating certain diseases in 
the pulp." About the same time, but independent of Fu} T t, Haf- 
ner, 4 of Zurich, utilized the reduced direct current for the same 
purpose. A year before the publication of Fuyt's and Hafner's 
observations, Schroder, 5 who was then director of the Dental In- 
stitute of the Universitv of Greifswald, had used the secondarv 
electric current for diagnosing diseases of the tooth pulp, and he 
published his observations in the annual report of that institution 
(1902). Since then quite an extensive literature on this interest- 
ing subject has appeared, the more important publications being 
those of Witthaus, 6 Grevers, 7 Hamburger, 8 Frohmann, 9 Hesse, 10 
An der Lahn, 11 Schroder, 12 Tousey, 13 etc. It is interesting to note 
that the various observers differ as far as the nature of the electric 



1 Woodward: Proceedings Philadelphia Academy of Stomatology, 1896. 

2 Inglis, Philadelphia: Private communication, 1908. 

3 Fuyt: Zahnarztliche Rundschau, 1902, p. 533. 

4 Hafner-Schurter: Schwe!zer Vierteljahrsschrif t fur Zahnheilkunde, 1902, No. 4. 

5 Schroder: Correspond en z Blatt fiir Zahnarzte, 1905, No. 1. 

6 Witthaus: D2utsche Monatsschrift fiir Zahnheilkunde, 1902, No. 11. 

7 Grevers: Dental Cosmos, 1903, p. 58. 

8 Hamburger: Deutsche Monatsschrift fiir Zahnheilkunde, 1907, No. 6. 

9 Frohmann: Deutsche Monatsschrift fiir Zahnheilkunde, 1907, No. 3. 

10 Hesse: Deutsche Monatsschrift fiir Zahnheilkunde, 1907, No. 3. 

11 An der Lahn: Osterreich-Ungarische Vierteljahrsschrift fiir Zahnheilkunde, 1907, No. 2. 

12 Schroder: Der Inductionsstrom als Diagnosticum in der Zahnarztlichen Praxis, 1907. 

13 Tousey: Dental Cosmos, 1909, p. 513. 



516 



APPENDIX. 



current is concerned. Fuyt advises the primary current and 
Schroder uses the secondary current of the faradic battery, while 
Hafner advocates the reduced direct current. The alternating 
current can not be used for such purposes. All investigators, how- 
ever, obtained precisely the same results. To judge from the 
various publications on the subject, coupled with our observations 
in the use of this method, the primary and secondary combined 




Figure 102. 

Typical Small Faradic Battery, with Induction Coil and Core Shield. The battery shows the 
hand electrode and the dental electrode connected with the combined current. 



faradic current is best suited for this work on account of the 
simplicity of the apparatus and the easy manner in which this 
current can be regulated. 

The Faradic Current and Its Accessories. — The faradic bat- 
tery delivers an easily controlled current of minute quantity. 
Two forms of induction coils, in connection with the battery, are 
in general use for this purpose — the induction coil with a core 



DIAGNOSIS OF PULP DISEASES. 517 

shield (the tube of Duchenne) and the sledge induction coil of 
Du Boys-Reymond. The source of electricity for the smaller in- 
duction coil is usually received from a single dip battery (acid 
potassium bichromate solution), 1 while the sledge induction coil 
may be fed from a series of batteries, or from the street current, 
which is reduced by a reostat. The small transportable induction 
coil with one dip battery gives universal satisfaction for the 
purpose in view, and on account of its cheapness, simplicity, and 
easy transportation deserves to be recommended. 

The induction coil produces a secondary current in a circuit 
placed near to, but not in contact with, the galvanic field. This 
galvanic field, the primary current, is represented by three or four 
layers of coarse copper wire, which are wound about the hollow, 
nonconducting cylinder, and the two ends of which are united 
with the binding posts. Within the cylinder is found a core of 
s'oft iron rods, which are covered in the simple induction coil by 
a movable brass tube (the tube of Duchenne). Outside of- the 
core and the primary current is a second coil, usually consisting 
of a great many turns of fine copper wire. The ends of this coil 
are also connected with the binding posts. When the current 
from the dip cell passes through the coil of coarse wire — the pri- 
mary current — a current is also produced in the secondary coil 
of fine wire because the passage of the primal*} 7 current makes 
the iron core strongly magnetic. A vibrator is placed in close 
proximity to the iron core. When the current passes through the 
primary coil and becomes magnetized, the steel spring of the 
vibrator is attracted and breaks the current. The magnet is now 
immediately released and the spring reasserts itself. The control 
of the current is guided by moving the brass tube; the gradual 
removal of the tube strengthens the current and vice versa. To 
furnish an approximate guide of the strength of the current, the 
tube of Duchenne is divided into ten equal parts by making file 
marks in the tube, or by pasting a narrow strip of paper, on which 
the divisions have been registered, on the tube. The divisions are 
referred to as degrees. In the sledge induction coil of Du Boys- 
Reymond the secondary coil is moved bodily over the primary 
current. The registration of intensity is marked on a scale 

1 Battery fluid for the dip battery: To 5 pints of water add, under constant stirring, 8 fluid- 
ounces of sulphuric acid in a thin stream. Dissolve at once 114 ounces of powdered potassium 
bichromate in the hot mixture; after cooling, the fluid is ready for use. 



518 APPENDIX. 

fastened to the apparatus, which is divided, according to the size 
of the apparatus, in 10, 50, or 100 degrees. This instrument is 
much more sensitive than the tube induction coil, and an exact 
differentiation between the various degrees is more readily ob- 
tained. 

The small faradic battery carries three binding posts and fur- 
nishes three definite currents. Posts 1 and 2 furnish the mild 
primary current, posts 2 and 3 furnish the more intense secondary 
current, while posts 1 and 3 furnish the strong combined current. 
The latter current is the one which is usually made use of for our 
purposes. The positive metallic hand electrode is held in the 
hand by the patient, while the negative pole carries the conduct- 
ing cord, to which a specific dental electrode is attached. This 
dental electrode may consist of a piece of hard rubber in the 
form of a penholder, with a piece of German silver wire passing 
through its body. A socket is left at each end for the attachment 







Figure 103. 
Dental Electrode. Charged with a wisp of cotton, ready for use. 

of the conducting cord and the platinum point. The latter is 
slightly roughened to carry a small piece of wet cotton ; it may 
be bent to any desired angle. A more serviceable dental electrode 
may be made as follows: The end of an opaque saliva tube is 
heated over a Bunsen flame, drawn to a point, and broken off so 
as to leave at its curved end a small opening about one-sixteenth 
of an inch in width. A piece of No. 26 German silver wire, about 
eight inches long, is soldered to a small disc of the same metal 
so as to fit the neck of the tube snugly at about one-quarter of 
an inch from its smaller opening. The wire is now loosely coiled, 
and its other end twisted to a spiral, which should fit the contact 
pin of the conducting cord. The coil is now pushed into the 
prepared glass tube, and, if necessary, cemented in place at its 
lower end. In using the electrode a piece of cotton -wet with salt 
water is inserted into the small opening and the other end is at- 



DIAGNOSIS OF PULP DISEASES. 519 

tached by means of the conducting cord to the negative pole 
of the battery. 

The Action of the Faradic Current on the Pulp. — The 
diagnosis of the condition of the pulp for clinical purposes re- 
solves itself into hyperemia, inflammation, and death of this organ. 
As far as simple hyperemia of the pulp is concerned, the routine 
therapeutic treatment is so well known that no further discussion 
is needed at this moment. If inflammation of the pulp is pres- 
ent — that is, when micro-organisms have gained access to the pulp 
— the experienced practitioner will lose no time in destroying this 
pulp. The treatment of a putrescent pulp is a matter of specific 
discussion, which has no interest at present. 

The action of the electric current on a sound tooth calls forth 
a definite sensation which is in accordance with the normal 
reaction of the patient to electric stimulation. The strength of 
the current needed for this purpose varies with the individual. 
The sensation manifests itself in a peculiar tingling sensation, but 
not in pain. This point is known as the irritation point {die 
Reizschwelle of the Germans). After having established the 
irritation point in the sound teeth of the patient, and after having 
expressed it in figures from the markings of the tube of Duchenne, 
it is a simple matter to distinguish a diseased pulp reaction from 
a normal pulp reaction. By applying these figures, a reliable 
clue for the diagnosis of existing diseases of the pulp is furnished. 
The following scheme may serve as a guide for making a diagnosis 
by means of the faradic current : 

1. The normal pulp responds to the faradic current at the 
irritation point. 

2. The irritated pulp responds to the faradic current at the 
irritation point, or just slightly below T it. 

3. The inflamed pulp responds to the faradic current below the 
normal irritation point. The more severe the inflammation, the 
more ready the response to the current. 

4. The inflamed pulp with pus infiltration (abscess formation) 
responds to the faradic current above the normal irritation point. 
The more severe the purulent condition, the less ready the re- 
sponse to the current. 

5. The dead pulp does not respond at all, not even to the full 
strength of the faradic current. 



520 APPENDIX, 

To illustrate this diagnostic scheme by figures as obtained from 
measurements with the tube of Duchenne, the following data 
may serve as examples: 

Degrees Diagnosis 

1. Upper central incisors 3.5 Normal irritation point. 

2. First upper right bicuspid 3 Pulp irritation. (The 

tooth shows a slight 
carious defect.) 

3. First lower right molar 1.5 Acute pulpitis. (The 

tooth shows a deep 
carious defect.) 

4. Second lower left molar 7.5 Purulent pulpitis. (The 

tooth is apparently in- 
tact; it has a large com- 
pound amalgam filling. ) 

5. Second upper left bicuspid No response Dead pulp. (The tooth 

from current. has a large cement fill- 
ing.) 

The Technique of Applying the Faradic Current to the 
Tooth. — The positive metallic hand electrode of the faradic bat- 
tery is held by the patient, or a wet cork or felt electrode is fastened 
to his wrist. The negative pole carries the dental electrode, which 
is manipulated by the operator. The current is started at its 
lowest amperage — that is, the tube of Duchenne is completely 
pushed over the core, or the sledge is started at zero. The irri- 
tation point of the patient is now obtained by holding the dental 
electrode against any of the apparently sound teeth. The upper 
central incisors are preferably selected for this purpose. The wet 
cotton of the electrode is placed near the center of the labial sur- 
face of the incisor, but always away from any present filling. 
The tube is now gradually withdrawn until slight, but distinct, 
sensation is noticed by the patient. The sensation must never 
be expressed as pain. The number on the scale of the tube is 
read, and the same maneuver is repeated on the other incisor. 
The average of the two readings furnishes the irritation point of 
the patient under treatment. It has been suggested by An der 
Lahn 1 to place both electrodes on the tooth, one lingually and 
one labially, and then pass the current directly through the crown 

1 An der Lahn: Loc. cit. 



DIAGNOSIS OF PULP DISEASES. 521 

of the tooth. This method does not give the same positive re- 
sults as when the current travels through the long axis of the 
tooth and thereby passes through the entire pulp. The average 
irritation point is not the same for every tooth and for every 
patient. A layer of thick enamel on a heavy body of dentin 
requires a stronger current and vice versa. Consequently the 
irritation point in the young is much lower than in old indi- 
viduals. The condition of the nervous system of the patient may 
also influence the response to the current; a disturbed psyche is 
usually much more sensitive to electric stimulation than a normal 
condition. If the electrode is placed on or very close to a metallic 
filling in a vital tooth, the response is very pronounced, and even 
painful, as compared to the same amount of current passing 
through a tooth without a metallic filling. This is also true if 
the electrode is placed on a thin shell of enamel which covers a 
metallic filling. The severity of the shock depends on the size 
of the filling. All filling materials — gold, amalgam, or the 
cements, with the exception of gutta-percha — are better electric 
conductors than enamel. The tooth under observation must be 
dry, and not in too close contact with its neighbors, as the current 
may switch to those teeth. The close proximity of large contour 
fillings or metallic crowns deserves special care. In such cases the 
rubber dam or strips of the dam placed between the adjacent 
teeth is necessary for isolation. The electrode must not be placed 
too near the gum line, or the gum tissue will react before the 
pulp is reached. The sensation felt on the gum is quite different 
from that in the pulp. It is not acute, but manifests itself as a 
tickling or crawling feeling. Devitalized teeth which carry fill- 
ings will also react if the electrode is placed on or near the filling ; 
they will not react if the electrode is placed on sound enamel, pro- 
vided that the root filling consists of gutta-percha. If the root 
carries a metallic post, a prompt shock is felt from the current. 
If a present filling reaches the gum line, a very quick and painful 
response is experienced, even from a mild current, when placed 
in contact with the filling. The absence of enamel acts some- 
what similar to the presence of a filling. A shock is usually pro- 
duced when the current is placed on exposed dentin, which must 



522 APPENDIX. 

therefore be avoided. A tooth with a dead pulp, but with a sound 
crown y will also react to the current if an acute pericementitis is 
present. Usually, however, a somewhat stronger current is re- 
quired than that which is necessary to establish the irritation 
point. In multirooted teeth the pulp may be dead in one canal 
and highly inflamed in another canal. In such cases a reaction 
similar to that obtained from purulent pulpitis is usually observed. 

The examination of the pulp by means of the faradic current 
requires a thorough mastering of the many details connected 
therewith. The practitioner can best familiarize himself with 
the current by using his own battery and induction coil, and by 
testing the instruments on himself and on an experimental patient. 
The teeth, gums, lips, and tongue are the organs which should be 
preliminarily tested. Before testing a tooth for pulp disturbances, 
it is always advisable to establish, if possible, the irritation point in 
the corresponding sound tooth of the opposite side of the jaw. 
The difference of the recorded figures furnishes the base for its 
diagnostic utilization. It is understood, of course, that no thera- 
peutic measures have been previously applied to the teeth under 
consideration or to the general system; their presence would ma- 
terially influence the reaction of the current. Some interesting 
experiments in this respect have been made by Schroder. 1 Mor- 
phin administered in average doses will reduce the reaction of the 
current three to four degrees below the normal irritation point. 
Its action manifests itself about fifteen to twenty minutes after 
its administration, and lasts from one and a half to two hours, 
while chloral hydrate in 15-grain (1 Gm.) doses acts within 
three to four minutes, and reduces the scale two to three degrees, 
but its action lasts only from ten to fifteen minutes. 

The action of bromids and of bromural is also very pro- 
nounced. Their administration for the purpose of reducing the 
hypersensitiveness of teeth which have to undergo operative pro- 
cedures are referred to under Sedatives. 

The faradic current as a diagnostic aid in pulp diseases is far 
superior to any other method so far known, but it should be 
remembered that it is not absolute in every case. 

1 Schroder: Loc. cit. 



URINE ANALYSIS. 523 

URINE ANALYSIS. 

Urine analysis as an aid in diagnosticating certain dental dis- 
eases is an essential adjunct to the clinical examination of the 
patient. Oral manifestation of typical general diseases — as 
diabetes, gout, autointoxication, etc. — are often the first pathogno- 
monic signs of these diseases. The correct diagnosis of the latter 
is verified by a urine analysis, and the patient may be surprised 
to learn that the presence of an odor of aceton from the oral 
cavity, together with the formation of pericemental abscesses and 
the rapid accumulation of soft white calcareous deposit about the 
teeth, should be indicative of diabetes, of which he has no knowl- 
edge at the time. The presence of sugar in the urine will verify 
the diagnosis. A urine analysis is also of important value to the 
dental practitioner if he intends to administer a general anes- 
thetic — chloroform or ether — to a patient. For the foregoing pur- 
poses an exhaustive examination of the urine is not necessary; 
it is merely intended to ascertain by a few simple tests the pres- 
ence or absence of albumin, of sugar, of the approximate amount 
of uric acid, etc. The determination of these substances may also 
indicate if the assistance of the family physician is desired in the 
treatment of the case under observation. An intelligent report 
made to the physician will not merely insure the co-operation of 
the later, but may also assist in bringing about a better under- 
standing and a much desired closer relationship of the two pro- 
fessions. 

The normal quantity of urine voided in twenty-four hours 
varies from 40 to 50 ounces (1,200 to 1,500 Cc). Free perspira- 
tion decreases the quantity, while chilling of the skin increases 
it. The greatest portion of urine- is passed during the day; dur- 
ing the night and the early morning hours the least portion is 
passed. Usually - the urine has a light, amber color, due to 
urobilin ; the color depends, however, largely on the quantity 
voided. On standing, nearly all normal urine assumes a cloudy 
appearance, which is due to the presence of mucus. The normal 
reaction of urine is slightly acid, due to uric acid, hippuric acid, or 
acid sodium phosphate. After meals the reaction may be neutral, 



524 APPENDIX. 

or even alkaline, for a short time. The normal specific gravity 
varies from 1.015 to 1.025; it is low when an increased amount 
is passed and high when the quantity is diminished. Normal 
urine has a peculiar, aromatic odor; it is altered by certain food 
or drugs — asparagus and oil of turpentine produce a violet-like 
odor, garlic gives a garlic-like odor, etc. 

The solid constituents of urine consist of organic and inorganic 
compounds, and they vary very markedly. The solids held in 
solution by and excreted with the urine within twenty- four hours 
amount to approximately : 

308 to 617 grains (20 to 40 Gm.) urea. 

6 to 12 grains (0.36 to 0.78 Gm.) uric acid. 

9 to 14 grains (0.54 to 0.90 Gm.) ammonium, calcium, magnesium 

potassium, and sodium urate. 
12 to 45 grains (0.72 to 2.9 Gm.) sodium phosphate. 
154 to 237 grains (10 to 25 Gm. ) sodium chlorid. 

General Examination. 

For the examination of the urine the mixed total quantity 
voided during twenty-four hours, or a part thereof, should be 
submitted. The preliminary inspection begins with the color of 
the sample ; the latter may be expressed as pale straw, straw, pale 
amber, amber, dark amber, reddish amber, etc., or after Vogel's 
scale of colors. It should not be forgotten that certain drugs 
which are taken internally may impart a distinctive color to the 
urine — santonin produces an intense yellow color, which changes 
to red or purple when alkalies are added ; methylen blue produces 
a blue color, etc. The odor is recognized as normal aromatic, as 
ammonical, or as putrid; the reaction is obtained with sensitive 
litmus paper. The specific gravity is readily determined by the 
urinometer, the specific gravity bottle, or by the specific gravity 
beads. If it is above 1.025, sugar in appreciable quantities may 
be expected. The instruments used for this work are usually 
corrected to conform to a temperature of 60° F. (15° C). If the 
temperature is above or below this standard, one degree of the 
urinometer has to be respectively added or subtracted for every 
5° F. (2.8° C). 



URINE ANALYSIS. 525 

Tests for Albumin. 

Serum albumin is the most often tested for of any constituent 
of the urine, and of the many tests which have been proposed 
the following are to be preferred. No single test is sufficient. 

1. Heat Test. — Boil the urine in a test tube ; when an opales- 
cence appears it indicates the presence of albumin or an excess 
of phosphates. If a few drops of nitric acid are now added, the 
cloudiness will disappear if due to phosphates, but will remain 
permanently if due to albumin. 

2. Purdy's Modified Heat Test. — Fill a test tube three-quar- 
ters full with urine and add saturated sodium chlorid solution to 
fill the tube ; now add two or three drops of strong acetic acid, and, 
holding the tube in the fingers by its bottom, heat the upper layer 
of the fluid until the mixture boils; then, without shaking the 
tube or its contents, examine the layer of fluid in the upper part 
of the tube, comparing its degree of transparency with that of 
the fluid that was not heated in the lower part of the tube. If 
the heated portion of the fluid is in the slightest degree hazy or 
less transparent, albumin is present. 

3. Heller's Nitric Acid Test. — A test tube is filled to the 
depth of one-half inch with nitric acid, and, while being held in 
an inclined position, the clear (filtered, if necessary) urine is 
allowed to trickle slowly down the inside surface from a medicine 
dropper, so as to form a superimposed layer on the urine. An 
opalescent ring at the junction of the two liquids indicates albu- 
min. Excess of urates, mucus, etc., sometimes gives rings re- 
sembling those of albumin, but on close observation these rings 
will be seen to be slightly above in the column of urine instead of 
at the bottom of contact. 

Tests for Sugar. 

Sugar occurs less frequently in the urine than albumin, and is 
usually present in urine having a very high specific gravity — 
above 1.025. If a sample of the urine contains albumin, it should 
always be removed by boiling and filtering before any of the tests 
for sugar are applied. 



526 APPENDIX. 

1. Fehling's Copper Test. — Equal volumes of the ordinary 
Fehling's solution are mixed in a test tube and heated to the boil- 
ing point ; if no reduction occurs, the solution may be considered 
safe, and the urine is now added drop by drop to the boiling 
Fehling's solution until an orange color or reddish precipitate 
forms, or until a volume of urine equal to that of the -copper solu- 
tion has been added. If there is no precipitate of orange or red- 
dish cuprous oxid, sugar may be considered absent. Simple dis- 
charging of the color of the formation of various bluish-gray 
precipitates must not be mistaken for a true reduction. 

2. Trommer's Modified Copper Test. — Place one inch of 
urine in a test tube and add one-half inch of potassium hydroxid 
solution, U. S. P., to the urine. Mix the two fluids by shaking 
the tube, and add two or three drops of a 5-percent solution of 
copper sulphate in distilled water. Do not heat the mixture, but 
allow the tube to stand undisturbed for twelve to twenty-four 
hours in the cold. At the expiration of that time, if sugar be 
present, there will be collected in the tube an ochre-yellow to 
brick-red precipitate of fine sand-like character of suboxid of 
copper. 

Quantitative Estimation of Sugar. 

The quantity of sugar in urine is very conveniently and quickly 
estimated by using "soloid" tablets of copper sulphate and alka- 
line tartrate. 1 It is based on Fehling's reduction test as follows : 

Prepare a standard test solution by dissolving four "soloids" 
copper sulphate in about 2 cubic centimeters of distilled water, and 
in this solution also dissolve 4 "soloids" alkaline tartrate, then 
•adjust to 4 cubic centimeters at 15° C. Each cubic centimeter 
corresponds to 0.005 gram of anhydrous glucose. It may be 
found more convenient to dilute the above measure of 4 cubic 
centimeters with an equal volume of water, when each cubic centi- 
meter of diluted test solution will correspond to 0.0025 gram of 
anhydrous glucose. Make a rough estimation by adding the urine 
to a definite volume of the boiling, test solution in such quantity 



1 " Soloid " tablets are made by Burroughs Wellcome & Co., of London and New York. 



URINE ANALYSIS. 527 

that, after boiling and allowing the precipitate to subside, the blue 
color of the reagent is just discharged. Now dilute the urine (if 
necessary) until it contains 0.5 to 1 percent of sugar, and make an 
accurate estimation with the diluted urine. 



Tests for Uric Acid. 

The presence of an excess of uric acid or of urates is usually 
readily detected by the physical appearance of the urine itself. 
If the urine has stood in a vessel from three to four hours, and a 
sediment of red sand ("brick dust deposit") is seen in the bottom 
of the vessel, it usually points to an excessive excretion of urates. 
The urates are more soluble in hot water than in cold water, and 
consequently the urine may be clear on voiding, but after becom- 
ing cold may deposit quite a sediment. The amorphous urates 
readily dissolve on warming. Under the microscope uric acid 
appears as whetstone-shaped crystals, which are sometimes ar- 
ranged in rosettes. These crystals are usually of a yellowish-red 
color. 

1. Hopkins' Test. — To 100 cubic centimeters of urine add 33 
grams of ammonium chlorid. Shake or stir until it dissolves, 
and then allow to stand in a cool place for three or four hours. 
Collect the precipitated ammonium urate on a filter, and wash 
with saturated ammonium chlorid solution until the filtrate is 
clean. Spread out the filter on a square glass plate, and wash 
the precipitate down over one corner of the plate and into a 
beaker or flask with hot water. The contents of the beaker are 
now heated to boiling with an excess (10 cubic centimeters) of 
hydrochloric acid, and allowed to stand in a cool place for several 
hours (not less than three), when the uric acid will crystallize 
out. This is collected on a small filter (the volume of the filtrate 
being noted) , and washed slightly with cold water. Wash off the 
filter into a flask with hot water, enough sodium carbonate solution 
being added to dissolve the uric acid, the volume is made up to 100 
cubic centimeters with water, 20 cubic centimeters of sulphuric 
acid are added, and a decinormal potassium permanganate solu- 
tion run in from a burette until a faint pink coloration remains 



528 APPENDIX. 

one minute after shaking. Each cubic centimeter of decinormal 
permanganate equals 0.007 gram of uric acid, to which must be 
added 0.001 gram for each 15 cubic centimeters of the filtrate 
before noted. 

2. Murexid Test. — Evaporate to dryness at a low heat over an 
alcohol lamp a few drops of urine in a watch crystal, add a drop 
or two of nitric acid, and again cautiously evaporate to dryness. 
A red residue will remain. Now add a drop or two of ammonia 
solution without at first letting it come directly in contact with 
the residue. The formation of murexid, which is shown by a 
beautiful purple color (purpurate of ammonia), indicates uric acid 
or urates. 

Test for Indican. 

Salkow t ski's Test. — Eight cubic centimeters of urine with 1 
cubic centimeter of a 10-percent copper sulphate solution are 
mixed with an equal volume of hydrochloric acid of a specific 
gravity of 1.19. A few cubic centimeters of chloroform are added, 
and the mixture inverted a number of times. The indican (indol- 
potassium sulphate) having been split up, the chloroform extracts 
the resulting indigo and takes on the characteristic blue color. 
The quantity is estimated by the depth of the blue color. 

If the urine contains albumin, it must be removed before apply- 
ing this test; otherwise the blue color often arising from the 
admixture of hydrochlorid acid after standing may prove mis- 
leading. (Purdy.) 

Test for Urobilin. 

Strauss' Test. — The urine is acidulated with acetic acid and 
cleared by the addition of one-fourth of its volume of 10-percent 
lead acetate solution and filtration. The filtrate is then shaken 
with amyl alcohol, the urobilin being thus extracted, as is shown 
by the yellow to deep orange color. The addition of ammonious 
zinc chlorid causes a fluorescence. Urobilin in very small quan- 
tities is present in healthy urine. 



TREATMENT OF ACUTE POISONING. 529 

IMMEDIATE TREATMENT OF ACUTE 

POISONING. 

General Directions. 

AVhen a poison has been swallowed, the stomach should at once 
oe evacuated with the stomach tube, or, in its absence, with a 
fountain syringe. If corrosives have been swallowed and the 
mucous membranes are greatly swollen, the stomach tube is not 
indicated, as laceration of the soft tissues may follow. Emetics 
are of prime importance. Certain metallic salts, especially copper 
sulphate in 3-grain (0.2 Gm.) doses, and zinc sulphate in 10-grain 
(0.65 Gm.) doses, dissolved in a glassful of water, act very 
promptly. If the patient is unable to swallow, apomorphin hydro- 
chlorid, 1 / 10 grain (0.006 Gm.), hypodermically, acts promptly 
and vigorously. As an emergency remedy a tablespoonful of 
ground mustard stirred in a cupful of tepid water usually produces 
quick vomiting. If the poison is of an unknown origin, emetics, 
bland liquids, and stimulants, together with suitable systematic 
treatment, is indicated. 

Acetic, Hydrochloric, Nitric, Nitro-Hydrochloric, and 

Sulphuric Acids. 

No emetic should be given. To dilute and neutralize the acid, 
milk mixed with chalk, whiting, magnesia, or baking soda, strong 
soap suds, or white of egg beaten up with water, is given ; later 
oil and mucilaginous drinks of flaxseed or slippery elm are indi- 
cated. Usually intense ulceration follows the acid burns. To 
relieve pain, morphin sulphate, 1 / i grain (0.015 Gm.), or tincture 
of opium, 15 drops (1 Cc), is administered. 

Hydrocyanic Acid and all Cyanids, Alcohol, Chloroform, 
Ether, Chloral Hydrate, Gasolin, Carbon Disulphid, 
and sulphurets of the alkalies. 

Hydrocyanic acid and cyanids require very prompt measures; 
they are quick and powerful poisons. Emetics may be given if 
necessary. The patient is put in a recumbent position, the head 



530 APPENDIX. 

lowered, and plenty of fresh air allowed for free respiration. Per- 
sistent artificial respiration should be instituted if needed. Keep 
the body warm, and try to arouse the patient with ammonia 
vapors; put cold douches to his head and apply friction to the 
extremities. Strong stimulants — whisky, nitroglycerin solution 
in V 2 -drop doses, etc. — are indicated. 

Oxalic Acid and its Salts. 

Give chalk or whiting mixed with two tablespoon fuls of vinegar 
and an equal quantity of water; do not give soda or potash with 
the object of neutralizing the acid. Vomiting should be induced 
at once and followed by olive oil or mucilaginous drinks. Gen- 
eral stimulants — whisky, etc. — and warmth applied to the ex- 
tremities are essential. 

Phenol (Carbolic Acid) and its Compounds, Cresol, Creo- 
sote, Lysol, and Resorcinol. 

Induce vomiting and give large quantities of diluted whisky or 
magnesium sulphate solution in the early stages. Remember that 
alcohol is not a chemic antidote for phenol or its compounds. 
Later give bland liquids, olive oil, and general stimulants as re- 
quired. 

Caustic Alkalies and Ammonia. 

Promote vomiting by large draughts of warm water. Mild 
acids in the form of diluted vinegar or lemon juice are indicated, 
which should be followed by olive oil, white of egg beaten up 
with water, and mucilaginous drinks. Severe pain calls for mor- 
phin sulphate, 1/ 4 grain (0.015 Gm.), or tincture of opium, 15 
drops (1 Cc). 

Arsenic and its Compounds. 

Promote vomiting with large draughts of warm water and 
administer at once hydrated oxid of iron (the official antidote 
for arsenic) or dialysed iron. The official antidote may be pre- 
pared extemporaneously by mixing a teaspoon ful of calcined mag- 
nesia with a cupful of water, add three teaspoonfuls of tincture 



TREATMENT OF ACUTE POISONING. 531 

of iron chlorid, mix well, and give the whole of it at once. This 
is to be followed with olive oil, white of egg beaten up with water, 
and mucilaginous drinks. 

Antimony Salts, Copper Salts, Iodin and its Preparations, 
Mercury Salts, Potassium Bichromate, Tartar Emetic, 
Tin and its Salts, Zinc and its Salts, Colchicum, Can- 

THARIDES, AND THE OlLS OF CROTON, SaVIN, AND PANSY. 

Induce vomiting, and is usually produced by the metallic salts 
themselves. Give large draughts of raw white egg (about half 
dozen or more) beaten up with water, or flour stirred in water, 
strong tea or coffee, and general stimulants. To relieve pain and 
tenesmus, morphin sulphate, V 4 grain (0.015 Gm.), is indicated. 

Barium and Lead Salts. 
Give magnesium sulphate, 4 drams (15 Gm.), or sodium sul- 
phate, 1 ounce (30 Gm.), dissolved in a large tumblerful of water. 
Promote vomiting with warm water or with mustard, and follow 
with milk and demulcent drinks. Pain is relieved by morphin 
sulphate, 1 / 4 grain (0.015 Gm.), or tincture of oipum, 15 drops 

(1 Cc). 

Silver Nitrate. 

Give common salt, one-half tablespoonful dissolved in a tumbler- 
ful of warm water, and induce vomiting; later, large draughts 
of demulcent drinks — starch, flaxseed, or slippery elm stirred in 
water — are indicated. 

Phosphorus (Rat Paste, Etc.). 
Give a prompt emetic — copper sulphate, 3 grains (0.03 Gm.), 
dissolved in a tumblerful of water — every five minutes. Old, thick 
oil of turpentine in 1-dram (4 Cc.) doses, suspended in flour 
water and repeated every hour, is much lauded. Do not give oils 
or fats. Milk of magnesia is often beneficial. When indicated, 
give general stimulants. 

Atropin, Cocain, Gelsemin, Pilocarpin, and all Prepara- 
tions Containing These Alkaloids. 
Induce vomiting, give large draughts of warm water, strong 
coffee and tea, and general stimulants. If the patient is drowsy, 



532 APPENDIX. 

rouse him with ammonia vapors; apply heat to the extremities 
and institute artificial respiration if necessary. 

Aconite, Cotton Root, Digitalis, Ergot, Lobelia, Tobacco, 
Veratrum, and Preparations Containing These Sub- 
stances. 

Give an emetic, which should be followed with large draughts 
of warm water, strong tea or coffee. Keep the patient in a hori- 
zontal position, apply warmth and friction to the extremities, and 
use artificial respiration if needed. 

^ Opium and its Preparations, Morphin and its Salts, and 

Indian Hemp. 
If necessary, vomiting should be induced. Give strong tea or 
coffee and large draughts of warm water. Keep the patient awake, 
and, if possible, in motion. A cold douche is beneficial. Strych- 
nin sulphate, 1 / 30 grain (0.002 Gm.), and atropin sulphate, 1 / 100 
grain (0.0006 Gm.), administered hypodermically, are often of 
benefit. Persistent artificial respiration should be kept up, even 
after life seems to be extinct. 

Nux Vomica and its Preparations, Strychnin and its Salts, 

AND FlSHBERRIES (CoCCULUS INDICUS) . 

Induce vomiting, followed by large draughts of warm water, and 
give tannic acid in 1-percent solution or iodid of starch. Spasms 
are relieved by inhalation of chloroform, or by chloral hydrate, 
15 grains (1 Gm.) dissolved in a tumblerful of water. Evacuate 
the bowels and give the patient absolute rest. 

FORMALDEHYD AND ITS SOLUTIONS. 

Give ammonia in very diluted solutions and demulcent drinks. 
General stimulants should be given when indicated. 

Wood Alcohol. 
Give immediately a tablespoonful of common salt dissolved in 
large tumblerful of warm water, and repeat at short intervals. 
If necessary, stimulate the respiration with strychnin sulphate, 
Vso grain (0.002 Gm.), hypodermically, and give strong coffee 
or tea. 



TREATMENT OF ACUTE POISONING. 533 

Decayed Meat or Vegetables. 

These materials are often productive of ptomain poisoning. 
Induce vomiting and cleanse the bowels with full doses of castor 
oil. Strong stimulants, and heat and friction applied to the ex- 
tremities, are beneficial. 

Poisonous Fungi. 

Evacuate the stomach as quickly as possible by promptly acting 
emetics. Give atropin sulphate, 1 / 100 grain (0.0006 Gm.), hypo- 
dermically, and tannic acid in the form of strong tea or coffee. 



634 APPENDIX, 



GLOSSARY OF THERAPEUTIC TERMS. 

The following are brief definitions of the more important tech- 
nical terms employed to designate the medicinal properties of 
remedies : 

Abortives — Drugs which produce abortion. 

Absorbents — Drugs which promote absorption. 

Abstergents — Detergents. 

Adjuvants — Substances which assist in the action of the principal 
drugs. 

Alteratives — Drugs which so favorably modify nutrition as to 
overcome morbid processes. 

Anesthetics — Drugs which produce general insensibility to pain. 

Anesthetics, local — Drugs which produce insensibility to pain in 
a localized area of tissue. 

Analeptics — Restorative drugs. 

Analgesics — Drugs which allay pain. 

Anaphrodisiacs — Drugs which depress sexual desire. 

Anodynes — Drugs which relieve pain. 

Antacids — Drugs which neutralize acids. 

Anthelmintics — Drugs which destroy intestinal worms. 

Antiarthritics — Drugs which relieve gout. 

Antiemetics — Drugs which relieve vomiting. 

Anticonvulsants — Drugs which relieve spasms. 

Antihydropics — Drugs t. hich relieve dropsical conditions. 

Antilithics — Dings which prevent the formation of stone 01 
calculus. 

Antiluetic ±— Antisyphilitics. 

Antipert >ics — Drugs Avhich relieve malarial or recurrent fevers. 

Antiphlogistics — Drugs which counteract inflammation and 
fever. 

Antipyretics — Drugs which reduce temperature or relieve fever. 

Antirheumatics — Drugs which relieve or prevent rheumatism. 

Antiseptics — Drugs which inhibit the growth of micro- 
organisms. 

Antisiaxogogues — Drugs which decrease the flow of saliva. 



GLOSSARY OF THERAPEUTIC TERMS. 535 

Antispasmodics — Drugs which relieve nervous irritability and 
spasms. 

Antisyphilitics — Drugs used in the treatment of syphilis. 

Antitoxins — Defensive proteins developed in the body as a result 
of the inoculation of a poison and acting as a neutralizer of the 
poison. 

Antizymotics — Drugs which inhibit fermentation. 

Aperients — Mild cathartics. 

Aphrodisiacs — Drugs which stimulate sexual impulse. 

Aromatics — Drugs characterized by a spicy odor and taste ; used 
to stimulate the mucous membrane of the intestinal tract. 

Astringents — Drugs which induce contractibility of tissues and 
arrest discharges. 

Blisters — Drugs which, applied locally, cause inflammatory 
exudation of serum ; produce vesication. 

Calefacients — Drugs which, applied externally, produce a sense 
of warmth. 

Cardiac Depressants — Drugs which decrease the heart's action. 

Cardiac Stimulants — Drugs which increase the heart's action. 

Carminatives — Drugs which expel air from the bowels; relieve 
flatulence. 

Cathartics — Mild purgatives which quicken and increase expul- 
sion from the bowels 

Caustics — Drugs which destroy living tissue. 

Cholagogues — Drugs which promote the flow of bile. 

Convulsants — Drugs which cause convulsions. 

Correctives — Drugs which correct or render more palatable the 
action of other drugs. 

Corrigents — Correctives. 

Counterirritants — Substances which, by counterirritation, re- 
lieve some other irritation. 

Demulcents — Mucilaginous substances which, in solution, soothe 
or protect inflamed or abraded surfaces. 

Dentifrices — Preparations which cleanse the teeth. 

Deodorants — Drugs which destroy foul odors. 

Depilatories — Substances which remove hair. 

Depletives — Drugs which remove fluids from the system. 



536 APPENDIX, 

Depressants — Sedatives. 

Detergents — Substances which cleanse or purify. 

Diaphoretics — Drugs which produce slight sweating. 

Dietetics — Substances which regulate the diet. 

Digestants — Ferments which aid digestion. 

Diluents — Substances which dilute secretions and excretions; 
also render drugs less irritant. 

Disinfectants — Drugs which chemically destroy and render in- 
fectious material sterile or inert. 

Diuretics — Drugs which increase or promote secretion of urine. 

Drastics — Drugs which produce violent purgation. 

Ecbolics — Drugs which accelerate labor. 

Emetics — Drugs which cause vomiting. 

Emmenagogues — Drugs which stimulate menstruation. 

Emollients — Substances which mechanically soften and protect 
tissues. 

Epispastics — Blisters. 

Errhines — Drugs which increase nasal secretions. 

Escharotics— Substances which produce caustic effects. 

Evacuants — Drugs which evacuate ; chiefly applied to purgatives, 
and also to emetics or diuretics. 

Expectorants — Drugs which act on the pulmonic mucous mem- 
brane and increase or alter its secretion. 

Febrifuges — Drugs which dispel or reduce fevers. 

Galactagogues — Drugs which increase the secretion of milk. 

Hemostatics— Drugs which arrest hemorrhage. 

Hepatics — Drugs which act on the liver. 

Hydragogues — Purgatives which cause large, watery discharges. 

Hypnotics — Drugs which produce sleep. 

Irritants — Drugs which cause irritation. 

Laxatives — Mild purgatives. 

Motor Excitants — Drugs which excite motor activity. 

Motor Depressants — Drugs which lessen motor activity. 

Mydriatics — Drugs which cause dilation of the pupil ; mydriasis. 

Myotics — Drugs which cause contraction of the pupil ; myosis. 

Narcotics — Drugs which produce sleep or stupor and simul- 
taneously relieve pain. 



GLOSSARY OF THERAPEUTIC TERMS. 537 

Neurotics — Drugs which act on the nervous system. 

Nutrients — Substances which nourish. 

Obtundents— ^-Drugs which locally alleviate pain by partial 
anesthesia. 

Oxytocics — Drugs which stimulate uterine contraction. 

Peristaltics — Drugs which increase peristalsis. 

Prophylactics — Substances which prevent contracting or de- 
veloping disease. 

Protectives — Drugs which protect a part. 

Ptyalagogues — Sialogogues. 

Purgatives — Drugs which cause copious discharge from the 
bowels. 

Refrigerants — Drugs which decrease the bodily temperature. 

Rbvulsants — Drugs which, by causing irritation, draw nervous 
force and blood from a distant diseased part ; coimterirritation. 

Rubefacients — Drugs which cause irritation and redness. 

Sedatives — Drugs which decrease functional activity. 

Sialogogues — Drugs which stimulate the salivary glands to secre- 
tion. 

SOM NIFACIENTS Soporifics. 

Soporifics — Drugs which cause profound sleep. 

Sorbefacients — Drugs which cause absorption. 

Specifics — Drugs which have a direct curative influence on cer- 
tain specific diseases. 

Stimulants — Drugs which increase functional activity. 

Stomachics — Stimulants to the stomach. 

Styptics — Local hemostatics. 

Sudorifics — Diaphoretics. 

Teniafuges — Drugs w T hich expel tape worms. 

Tonics — Drugs which restore the normal tone by stimulating 
nutrition. 

Topics — Local applications. 

Vermicides — Drugs which kill intestinal worms. 

Vermifuges — Drugs which cause expulsion of intestinal worms. 

Vesicants — Blisters. 

Vulneraries — Drugs which promote healing of wounds. 



538 



APPENDIX. 



DIAGNOSTIC AIDS. . 



Frequency of Pulse. 

At birth 130 to 150 times a minute. 

At the first year 100 to 130 

At the seventh year 72 to 90 

At the time of puberty 80 to 85 

At middle life 69 to 75 

At old age 50 to 60 



Frequency of Respiration. 

At the first year 35 times a minute. 

At the second year 25 ' ' ' ' 

At the time of puberty • . . 20 " " 

Above twenty years of age 18 " 



Temperature of the Body. 

Normal temperature 97V2 to 98y 2 F c (36.3° to 36.9° C. ) 

Feverishness 99° to 100° F. (37.3° to 37.8° C.) 

Slight fever 100° to 101° F. (37.8° to 38.4° C.) 

Moderate fever 102° to 103° F. (38.9° to 39.5° C.) 

High fever 104° to 105° F. (40.° to 40.6° C.) 

Intense fever 105° F. (40.6° C.) 



Comparison Between Temperature and Pulse. 



A temperature of 98° 


F. 


(36.7° C.) 




99° 


F. 


(37.2° 


C) 




100° 


F. 


(37.8° 


C) 




101° 


F. 


(38.4° 


C.) 




102° 


F. 


(38. .9° 


C.) 




103° 


F. 


(39.5° 


C) 




104° 


F. 


(40.° 


C) 




105° 


F. 


(40.6° 


C) 




106° 


F. 


(41.2° 


C) 



C. ) corresponds to a 



a 



pulse of 60 

70 

80 

90 

100 

110 

120 

130 

" 140 



THERMOMETRY EQUIVALENTS. 



539 



THERMOMETRIC EQUIVALENTS. 

To reduce Centigrade degrees to those of Fahrenheit, multiply 
by 9, divide by 5, and add 32; or, degrees Centigrade X 1.8+32= 
degrees Fahrenheit. 

To reduce Fahrenheit degrees to those of Centigrade, subtract 
32, multiply by 5, and divide by 9; or, degrees — 32-^-1.8= 
degrees Centigrade. 



Degrees 


Degrees 


Degrees 


Degrees 


Cent. 


Fahr. 


Cent. 


Fahr. 


Cent. 


Fahr. 


Cent. 


Fahr. 


— 20 


— 4. 


17 


62.6 


54 


129.2 


91 


195.8 


— 19 


— 2.2 


18 


64.4 


55 


131. 


92 


197.6 


— 18 


— 0.4 


19 


66.2 


56 


132.8 


93 


199.4 


— 17 


1.4 


20 


68. 


57 


134.6 


94 


201.2 


— 16 


3.2 


21 


69.8 


58 


136.4 


95 


203. 


— 15 


5. 


22 


71.6 


59 


138.2 


96 


204.8 


— 14 


6.8 


23 


73.4 


60 


140. 


97 


206.6 


— 13 


8.6 


24 


75.2 


61 


141.8 


98 


208.4 


— 12 


10.4 


25 


77. 


62 


143.6 


99 


210.2 


— 11 


12.2 


26 


78.8 


63 


145.4 


100 


212. 


— 10 


14. 


27 


80.6 


64 


147.2 


101 


213.8 


— 9 


15.8 


28 


82.4 


65 


149. 


102 


215.6 


— 8 


17.6 


29 


84.2 


66 


150.8 


103 


217.4 


— 7 


19.4 


30 


86. 


67 


152.6 


104 


219.2 


— 6 


21.2 


31 


87.8 


68 


154.4 


105 


221. 


— 5 


23. 


32 


89.6 


69 


156.2 


106 


222.8 


— 4 


24.8 


33 


91.4 


70 


158. 


107 


224.6 


— 3 


26.6 


34 


93.2 


71 


159.8 


108 


226.4 


— 2 


28.4 


35 


95. 


72 


161.6 


109 


228.2 


— 1 


30.2 


36 


96.8 


73 


163.4 


110 


230. 





32. • 


37 


98.6 


74 


165.2 


111 


231.8 


1 


33.8 


38 


100.4 


75 


167. 


112 


233.6 


2 


35.6 


39 


102.2 


76 


168.8 


113 


235.4 


3 


37.4 


40 


104. 


77 


170.6 


114 


237.2 


4 


39.2 


41 


105.8 


78 


172.4 


115 


239. 


5 


41. 


42 


107.6 


79 


174.2 


116 


240.8 


6 


42.8 


43 


109.4 


80 


176. 


117 


242.6 


7 


44.6 


44 


111.2 


81 


177.8 


118 


244.4 


8 


46.4 


45 


113. 


82 


179.6 


119 


246.2 


9 


48.2 


46 


114.8 


83 


181.4 


120 


248. 


10 


50. 


47 


116.6 


84 


183.2 


121 


249.8 


11 


51.8 


48 


118.4 


85 


185. 


122 


251.6 


12 


53.6 


49 


120.2 


86 


186.8 


123 


253.4 


13 


55.4 


50 


122. 


87 


188.6 


124 


255.2 


14 


57.2 


51 


123.8 


88 


190.4 


125 


257. 


15 


59. 


52 


125.6 


89 


192.2 


126 


258.8 


16 


60.8 


53 


127.4 


90 


194. 


127 


260.6 



540 



APPENDIX. 



DOSE TABLE. 

The closer given in this table are those commonly employed for 
adults and per mouth unless otherwise stated. The figures in the 
first column of doses represent grains when the remedy is a solid 
and minims when it is a liquid. The figures in the second 
column signify grams when the remedy is a solid and cubic 
centimeters when it is a liquid. 



Remedy 



Abstract, aconite 

aspidosperma 

belladonna 

cannabis indica. .... 

conium 

digitalis 

gelsemium 

hyoscyamus 

ignatia 

ipecac 

jalap 

nux vomica 

Phytolacca 

pilocarpus 

podophyllum. 

senega 

valerian 

veratrum viride 

Acetanilid 

Acetal 

Acetone 

Acid, acetic 

agaricic 

anisic 

arsenous 

benzoic 

boric 

cacodylic 

camphoric 

carbolic 

cathartic 

citric 

cubebic 

di-iodo-salicylic 

filicic, amorphous. . . 

gallic 

gynocardic . . . : 

hydriodic 

hydrobrom, diluted . 

hydrochlor 

diluted 

hydrocinnamic 

hydrocyanic, diluted 



Grains or minims 


Gram? *>r Cc. 


M— % 


0.015 


- 0.03 


5 — 20 


0.3 


- 1.3 


V-i - Wi 


0.03 


- 0.1 


1 — 3 


0.06 


— 0.2 


1 — 2 


0.06 


— 0.13 


1 — 3 


0.06 


— 0.2 


1 — 3 


0.06 


— 0.2 


2 — 5 


0.13 


— 0.3 


1 — 3 


0.06 


— 0.2 


3 — 20 


0.03 


— 1.3 


5 — 10 


0.03 


— o.e 


M-V2 


0.015 


— 0.0* 


5-15 


0.3 


— 1. 


5 — 20 


0.3 


— 1.3 


2 — 5 


0.13 


— 0.3 


5 — 10 


0.3 


— 0.6 


5-15 


0.3 


— 1. 


1 — 1 


0.06 


— 0.13 


3 — 10 


0.2 


— 0.6 


120 — 180 


8. 


— 12. 


5 — 15 


0.3 


— 1. 


15 — 40 


1. 


— 2.5 


Ve — V 2 


0.01 


— 0.03 


5 — 15 


0.3 


— 1. 


Vro — -V^o 


0.001 


— 0.000? 


10 — 30 


0.6 


— 2. 


5 — 15 


0.3 


— 1. 


1 — 3 


0.06 


— 0.2 


10 — 30 


0.06 


— 2. 


i/2-2 


0.03 


— 0.13 


2 — 6 


0.13 


— 0.4 


10 — 30 


0.6 


— 2. 


5 — 10 


0.3 


— 0.6 


8 — 20 


0.5 


— 1.3 


8 — 15 


0.5 


— 1. 


5 — 20 


0.3 


— 1.3 


y 2 — 3 


0.03 


— 0.2 


5 — 10 


0.3 


— 0.6 


30 — 90 


2. 


— 6. 


3 — 10 


0.2 


— 0.6 


10 — 30 


0.6 


— 2. 


10 — 20 


0.6 


— 1.3 


2 — 5 


0.13 


— 0.3 



DOSE TABLE. 



541 



Remedy 



Acid, hypophosphorous 

lactic 

laricic (agaricic) . ■ 

mono-iodosalicylic 

naphtionic 

nitric, diluted 

nitro-hydrochlorid, diluted 

osmic 

oxalic 

oxynaphtoic 

paracreosotic 

phenylacetic 

phosphoric 

diluted 

picric 

propylacetic 

quinic 

salicylic 

santoninic 

sclerotic 

succinic 

sulphanilic 

sulphuric, aromatic 

diluted 

sulphurous 

tannic 

tartaric 

valerianic 

Aconapellin 

Aconitin, cryst 

Adonidin 

Agaricin 

Agathin 

Agoniadin 

Airol : 

Alantol 

Alcohol, methylic 

Aletrin .-...<.... 

Allyl, sulphid 

tribromid 

Alnuin 

Aloes , 

purified 

Aloin 

Alphol 

Alphozon 

Alum 

emetic 

ammonioferric 

Aluminium acetate 

chlorid 

Ammonia water 

cone 

Ammoniac 

Ammonium, acetate 



Grains or minims 



3 — 10 

15 — 30 

% — % 

15 — 45 

10 — 20 

5 — 30 

5 — 20 

Vg± 

72 — 1 

1 — 3 

2 — 20 
2 — 4 

2 — 6 
20 — 60 
72 — 2 

3 — 5 
8 — 20 

10 — 40 

1 — 5 
V2-I 

5 — 15 
10 — 20 
10 — 20 
15 — 30 
15 — 60 

2 — 20 
10 — 30 

2 — 10 
■V12 

XL 



1 {, 



724 

7640 — 7200 
1A „ _ V< 



716 

Va 



l /4 
-1 

2 — 8 

2 — 4 

2 — 5 

Ve — V2 

10 — 40 

1 — 3 

"daily 

1 — 2 
5 — 10 

2 — 5 



2 

1 

1/0 



20 
10 
2 
8 — 15 

y 2 -2 

5 — 15 
60 — 120 

5 — 15 

5 — 10 

1 — 5 
10 — 30 

4 — 10 

5 — 15 
15 — 30 



Grams or Cc. 



0.2 

1. 

0.01 

1. 

0.6 

0.3 

0.3 

0.001 

0.03 

0.06 

0.13 

0.13 

0.13 

1.3 

0.03 

0.2 

0.5 

0.6 

0.06 

0.03 

0.3 

0.6 

0.6 

1. 

1. 

0.13 

0.6 

0.13 

0.0025 

0.0001 

0.004 

0.015 

0.13 

0.13 

0.13 

0.01 

0.6 

0.06 

0.06 

0.3 

0.13 

0.13 

0.06 

0.03 

0.5 

0.03 

0.3 

4. 

0.3 

0.3 

0.06 

0.6 

0.25 

0.3 

1. 



daily 



0.6 

2. 

0.03 

3. 

1.3 

2. 

1.3 

0.06 

0.2 

1.3 

0.25 

0.4 

4. 

0.13 

0.3 

1.3 

2.5 

0.3 

0.06 

1. 

1.3 

1.3 

2. 

4. 

1.3 

2. 

0.6 

0.005 

0.0003 

0.016 

0.06 

0.5 

0.25 

0.3 

0.03 

2.5 

0.2 

r 

0.13 

0.6 

0.3 

1.3 

0.6 

0.13 

1. 

0.12 

1. 

8. 

l; 

0.6 

0.3 

2. 

0.6 

1. 

2. 



542 



APPENDIX. 



Remedy 



Grains or minims 



Grams or Cc. 



Ammonium, arsenate' 

benzoate 

. bicarbonate 

bisulphate 

bisulphite 

borate , 

bromid 

camphorate 

carbolate 

carbonate 

chlorid ^ 

embelate ? 

chlorid, f errated 

fluorid 

formate 

glycerino-phosphate . . . 

hypophosphite 

hyposulphite , . . 

iodid 

phosphate 

picrate 

salicylate 

succinate 

sulphite 

sulphocarbol 

tartrate 

valerianate 

and iron tart 

Ammonamid 

Ammonol 

salicylate 

Ampelopsin 

Amygdophenin 

Amyl nitrite 

salicylate, daily 

valerianate 

Amylamine, hydrochlorate. 
Amylen-chloral 

hydrate 

Anesthesin 

Analgen 

Anemonin 

Anilin sulphate 

Anilipyrin 

Anthemin 

Antiarthrin 

Antifebrin, acetanilid 

Antikol 

Antimony arsenate 

iodid 

oxid 

and potassium tart 

Antinervin 

Antipyrin 

salicylate 

tannate 



V20 

10 

5 

10 

10 

10 

15 

1 

2 

5 

5 

3 

4 

1 /i2- 

5 

3 

10 
5 
3 
5 

\k 
2 
1 
5 
1 
5 
2 

10 
5 
5 
8 
2 
5 
2 

30 
3 
3 
8 

15 
5 
5- 

V4- 
%■ 

15 
1 
6 
3 
3 

y 60 - 

%- 

l- 

%2- 

10- 

10- 

5- 

20- 



30 
-15 

30 

30 
-20 

30 

3 

6 

20 
■20 

6 

12 
■% 

10 

6 

30 

30 

5 

20 

iy 2 

10 

3 
•20 

5 

30 
-8 

30 

15 

20 

20 

4 

15 

5 

6 
15 
30 
30 

15 

1 

IVi 

30 

3 

10 

10 

10 

Vm 

1 

3 

% 

20 

20 

15 

45 



0.003 

0.6 

0.3 

0.6 

0.6 

0.6- 

1. 

0.06 

0.13 

0.3 

0.3 

0.2 

0.25 

0.005 

0.3 

0.2 

0.6 

0.3 

0.2 

0.3 

0.015 

0.13 

0.06 

0.3 

0.06 

0.3 

0.13 

0.6 

0.3 

0.8 

0.5 

0.13 

0.3 

0.13 

2. 

0.2 

0.3 

0.5 

1. 

0.3 

0.3 

0.015 

0.05 

1. 

0.06 

0.4 

0.2 

0.2 

0.001 

0.015 

0.06 

0.002 

0.6 

0.6 

0.3 

1.3 



0.006 

2. 

1. 

2. 

2. 

1.3 

2. 

0.2 

0.4 

1.3 

1.3 

0.4 

0.8 

0.05 

0.6 

0.4 

2. 

2. 
0.3 

1.3 

0.1 

0.6 
0.2 

1.3 

0.3 

2. 

0.5 

2. 

1. 

1.3 

1.3 

0.25 

1. 

0.3 

0.4 
1. 
2. 
2. 

1. 

0.06 
0.1 
2. 
0.2 
0.6 
0.6 
0.6 

0.0002 
0.06 
0.2 
0.008 
1.3 
1.3 
1. 
.3 



DOSE TABLE. 



543 



Remedy 



Grains or minims 



Grams or Cc. 



Antirheumaticum 

Antisepsin 

Antispasmin 

Antithermin 

Apiol, cryst 

fluid 

Apiolin 

Apocodein hydrochlorate . . 

Apolysin 

Apomorphin, hydrochlorid 

Arbutin 

Arsenhemol 

Arsenic bromid 

chlorid 

iodid 

Asaf etida 

Asaprol 

Asclepin 

Asepsin 

Aspidium 

Aspidospermin 

Aspirin 

Atropin 

Avenin 

Balsam, fir 

gurjun 

peru 

tolu 

traumatic 

Baptisin 

Barium chlorid 

iodid 

sulphid 

Barosmin 

Basham's mixture 

Bebeerin 

Benzacetin 

Benzanlid 

Benzene (benzol) 

Benzonaphthol 

Benzoparacresol 

Benzosol 

Benzoyleugenol 

Berberin 

hydrochlorid 

sulphate 

Betin ■. 

Betol 

Bismal 

Bismuth, albuminate 

benzoate 

betanaphtol 

carbolate 

citrate 

lactate 



1 

2 
% 

1 

5 

5 

3 
% — 

8 — 

1/20 — 



5 

1 

Veo 

Veo 

Veo 

5 

5 

2 

2 

30 

1 

5 

Y20 

V20 

5 

10 
10 

5 
30 

Y 2 

^10 

V10 

y-2 
2 

240 



IV2 
2 

5 
4 
3 

8 

Vo 



2 
3 
15 
10 

1 
24 

% 
15 
3 

%5 

Vl5 

Vlo 

15 

15 

4 

8 

90 

2 

30 

VfiO 



30 
60 
30 
15 
60 
5 
■% 

■y-> 

1 

4 

480 

IV2 

15 

15 

10 

15 

8 

15 

15 

1% 

10 

15 

4 

8 

5 

15 

15 

15 

15 

3 

15 



0.06 

0.13 

0.01 

0.06 

0.3 

0.3 

0.2 

0.02 

0.5 

0.003 

0.3 

0.06 

0.001 

0.001 

0.001 

0.3 

0.3 

0.13 

0.13 

2. 

0.06 

0.3 

0.0005 

0.0005 

0.3 
0.6 
0.6 
0.3 
2. 

0.03 
0.006 
0.006 
0.03 
0.13 
15. 
0.03 
0.5 
0.1 
0.13 
0.3 
0.25 
0.2 
0.5 
0.3 
0.3 
0.5 
0.13 
0.25 
0.13 
0.3 
0.3 
0.3 
0.3 
0.06 
0.3 



0.13 

0.5 

0.13 

0.2 

1. 

0.6 

0.06 

1.5 

0.008 

1. 

0.2 

0.004 

0.004 

0.004 

1. 

1. 

0.25 

0.5 

6. 

0.13 

2. 

0.001 

0.001 

2. 

4, 

2. 

1. 

4. 

0.3 

0.03 

0.03 

0.06 

0.25 

;o. 
1. 
1. 
1. 

0.6 

1. 

0.5 

1. 

1. 

0.1 

0.6 

1. 

0.25 

0.5 

0.3 

1. 

1. 

1. 

1. 

0.2 

1. 



544 



APPENDIX. 



Remedy 



Bismuth, nitrate (tri-) 

oxid , 

oxybromid , 

oxyiodid (subiod. ) 

peptonized 

phosphate, soluble 

pyrogallate 

resorcinate 

salicylate, acid 

salicylate (basic) , 

subcarbonate 

subgallate 

subiodid = bismuth oxy-iodid. 

subnitrate 

tannate , 

valerianate 

and ammonium citrate 

and cinchonid. iodid 

Bismuthan 

Blennostasin 

Borax 

Boroglycerin 

Borol 

Brayerin 

Brenzcain 

Bromalbacid. 

Bromal hydrate 

Bromalin 

Bromamid 

Bromin 

Bromipin (10 percent) 

Bromochinal 

Bromocoll 

Bromof orm 



Grains or minims 



Grams or Cc. 



Bromo-hemol 

Brucin 

Bryonin 

Butyl-chloral hydrate . 



Cadmium sulphate 

Caffein triiodid 

Caff ein 

citrated 

hydrobromate 

and sodium benzoate . 

and sodium salicylate 

Calcium, benzoate 

borate 

bromid 

bromo-iodid 

carbolate 

carbonate 

chlorid 

eosolate 

dioxid 



5 — 10 
5 — 15 
5 — 6 
3 — 10 
30 — 60 
3 — 10 
5 — 15 

3 — 8 
5 — 10 
5 — 15 
5 — 30 

4 — 8 
3 — 10 

5 — 40 
10 — 30 

1 — 3 

2 — 5 
Vg — % 

8 — 15 

5 — 20 
20 — 40 
30 — 90 

5 — 10 
15 — 30 

1 — 5 
15 — 30 

3 — 15 
20 — 60 

5 — 15 

1 — 3 
60 — 240 
10 — 12 
15 — 75 

2 — 20 
drops 

15 — 30 
V12 — V2 
%— 2 
5 — 20 

V12 — % 

iy 2 — 4 

1 — 5 

2 — 10 

2 — 6 

3 — 10 
3 — 10 

10 — 30 

1 — 5 
10 — 30 

5 — 10 

2 — 5 
10 — 40 

5 — 20 
5 — 15 

3 — 10 



0.3 

0.3 

0.3 

0.2 

2. 

0.2 



3 
2 
3 

3 

3 
0.25 
0.2 
0.3 
0.6 
0.06 
0.13 
0.01 
0.5 
0.3 
1.3 
2. 
0.3 
1. 

0.06 
1. 
0.2 
1.3 
0,3 
0.06 
4. 
0.6 
1. 



1. 

0.005 
0.015 
0.3 

0.005 

0.1 

0.06 

0.13 

0.13 

0.2 

0.2 

0.6 

0.6 

0.6 

0.3 

0.13 

0.6 

0.3 

0.3 

0.2 



0.6 
1. 
0.4 
0.6 
4. 
0.6 
1. 
0.5 
0.6 
1. 
2. 
0.5 
0.6 
2.5 
2. 
0.2 
0.3 
0.05 
1. 
1.3 
2.5 
6. 
0.6 
2. 
0.3 
2. 
1. 
4. 
1. 

0.2 
15. 
0.75 
5. 



2. 

0.03 
0.13 
1.3 

0.01 

0.25 

0.3 

0.6 

0.4 

0.6 

0.6 

2. 

0.3 

2. 

0.6 

0.3 

2.5 

1.3 

1. 

0.6 



DOSE TABLE. 



545 



Remedy 


Grains or minims 


Grams or Cc. 


Calcium, f errophospholactate 

glycerinophos 

hippurate 


3 — 8 
3 — 10 
5 — 15 
10 — 30 
3 — 10 

2 — 5 

3 — 4 
3 — 10 
3 — 10 

10 — 20 
1 — 2 

1/6 — 1/2 

10 — 30 

8 — 20 

1/2 — I1/2 

IV2 — 3 

1 — 5 

5 — 15 

1 — 3 

1/8 — 1 

5 — 15 

2 — 5 
5 — 10 

3 — 10 

2 — 5 
1 — 5 
1 — 5 
8 — 15 

1/3 — I 

1/2-I1/2 

1/1600 

i/io — i/i 

1 — 5 

3 — 8 
5 — 8 

■^240 1/60 

1 — 3 
1 — 5 
5 — 10 
11/2 — 3 
10 — 30 
IV2 — 3 
I1/2 — 3 
3 
10 — 30 

1 — 2 
10 — 40 

2 — 4 
5 — 10 
1 — 3 

10 — 30 

15 — 45 

15 — 30 

8 — 15 

3 — 6 
subcut. 


0.2 

0.2 

0.3 

0.6 

0.2 

0.13 

0.2 

0.2 

0.2 

0.6 

0.06 

0.01 

0.6 

0.5 

0.03 

0.1 

0.06 

0.3 

0.06 

0.02 

0.3 

0.13 

0.3 

0.2 

0.13 

0.06 

0.06 

0.5 

0.02 

0.03 

0.000 

0.006 

0.06 

0.2 

0.3 

0.000 

00.6 

0.06 

0.3 

0.1 

0.6 

0.1 

0.1 

0.2 

0.6 

0.06 

0.6 

0.13 

0.3 

0.06 

0.6 

1. 

1. 

0.5 

0.2 


— 0.5 

— 0.6 

— 1. 


hypophos 


— 2. 


hyposulphite 


— 0.6 


iodid 


— 0.3 


iodate 

lactate 


— 0.25 

— 0.6 


lactophosphate 


— 0.6 


phosphate 


— 1.3 


permanganate 


— 0.13 


quinovate 


— 0.03 


saccharate 


— 2. 


salicylate 


— 1.3 


santoninate 


— 0.1 


sulphid, yellow 


— 0.2 


sulphite 


— 0.3 


sulphocarbol 


— 1. 


Calendulin 


— 0.2 


Calomel 


— 0.06 


cathartic 


— 1. 


Camphor 


— 0.3 


carbolated 


— 0.6 


citrated 


— 0.6 


monobrom 


— 0.3 


salicylated 


— 0.3 


valerianated 


— 0.3 


Cannabin tannate 


— 1. 


Cannabindon 


— 0.06 


Cannabinon -. 


— 0.1 


Cantharidin 


34 


Capsicin 


— 0.015 


Capsicum , 


— 0.3 


Carnif errin 


— 0.5 


Cellotropin 


— 0.5 


Cerberin 


25— 0.001 


Cerium nitrate 


— 0.2 


oxalate 


— 0.3 


Cerolin 


— 0.6 


Cetrarin 


— 0.2 


Charcoal 


— 2. 


Chelidonin, phosphate 


— 0.2 


sulphate 


— 0.2 


tannate 




Chelidonium 


— 2. 


Chelonin 


— 0.1 


Chenopodium .- 


— 2.5 


Chimaphilin 


— 0.25 


Chinaphenin 


— 0.6 


Chionanthin 


— 0.2 


Chirata 


— 2. 


Chloralamid 


— 3. 


Chloral-ammonia 


— 2. 


Chloralbacid 


— 1. 


Chloral-caffein 


— 0.4 




subcut. 



546 



APPENDIX. 



Remedy 



Grains or minims 



Chloralformamid . 
Chloral hydrate. . . 

Chloralimid 

Chloralose 

Chloral-urethane. . 

Chloretone 

Chlorin water 

Chlorobrom 

Chlorodyne 

Chloroform 

Chloropepsoid 

Chrysarobin 

Cimicifuga 

Cimicifugin 

Cinchona 

Cinchonidin 

Cinchonin 

iodosulphate . . 

Cinnamon 

Cinnamyl-eugenol 



Citarin 

Citrophen 

Citmllin 

Cobalt and potassium nitrite. 
Cocain carbolate 

hydrochlorid 

Codein 

phosphate 



Colchicein 

Colchicin 

salicylate 

Collargol 

Collinsonin 

Colocynth 

Colocynthin 

Columbin 

Condurangin 

Coniin hydrobrom 

Contradolin 

Convallamarin — 

Convallarin 

Convolvulin 

Copaiva 

Copper, acetate . . 

arsenite 



nitrate 

oxid, black 

phosphate 

sulphate 

emetic 

and ammonium sulphid 

Cordol... 

Coriamyrthin 



15 — 45 

10 — 30 

15 — 30 

3 — 12 

10 — 45 

6 — 20 

60 — 240 

60 — 120 

5 — 20 

2 — 5 

60 — 120 

Vs — Vi 

5 — 30 

V-2 — 2 

5 — 15 

1 — 2 

1 — 2 

1 — 5 
10 — 30 

2 — 8 
subcut. 
15 — 30 

8 — 15 

% — Vh 

M — % 

Mi — % 

%— m 

% - 2 

Vi — l 
subcut. 

MiO ^iO 

Mao- Vm 

Yso 

1 — 3 

2 — 4 

3 — 10 
% — % 
V-i — 1 

Mo — % 
%o — Ms 

4 — 8 

3 /2 — 1 

2 — 4 

1 — 3 
20 — 60 

y 8 — m 

Mao every 

V-2 hour 
i / i/ 
J /i2 — Ve> 

% — m 

Vs — V2 

V<s — Vs 

2 — 5 

y 2 — 2 

15 — 30 



Grams or Cc. 



700 



1. 

0.6 

1. 

0.2 

0.6 

0.4 

4. 

4. 

0.3 

0.13 

.4. 

0.008 

0.3 

0.03 

0.3 

0.06 

0.06 

0.6 

0.6 

0.13 

1. 

0.5 

0.01 

0.015 

0.005 

0.03 

0.03 

0.03 



— 3. 

— 2. 

— 2. 

— 0.8 

— 3. 

— 1.3 

— 15. 

— 8. 

— 1.3 

— 0.3 

— 8. 

— 0.015 

— 2. 

— 0.13 

— 1. 

— 0.13 

— 0.13 

— 0.3 

— 2. 

— 0.5 
subcut. 

— 2. 

— 1. 

— 0.02 

- 0.03 

- 0.01 

- 0.1 

- 0.13 

- 0.06 



subcut. 



0.0005 — 

0.0005 — 
0.00075 

0.06 — 

0.13 — 

0.2 — 

0.01 — 

0.03 — 

0.006 — 

0.001 — 

0.25 — 

0.03 — 

0.13 — 

0.06 — 

1.3 — 

0.008 — 



0.001 
0.002 

0.2 

0.25 

0.6 

0.04 

0.06 

0.015 

0.004 

0.5 

0.06 

0.25 

0.2 

4. 

0.015 



0.005 every V2 
hour 
- 0.01 



0.005 

0.05 

0.008 

0.01 

0.13 

0.03 

1. 



0.01 

0.03 

0.02 

0.3 

0.13 

2. 

0.001 



DOSE TABLE. 



547 



Remedy 



Cornin 

Cornutin citrate 

Coronillin 

Cosaprin 

Cotarnin hydrochlorid (stypticin) 

Cc toin 

Creatin 

CreatLnin 

Creolin 

Creosotal .... 

Creosote 

carbonate 

phosphate 

phosphite 

.valerianate 

Cresol, meta. 

Cubebs 

Cupro-hemol 

Curare 

Curarin 

Cypripedin 

Cystogen 

Cytisin hydrochlorid 

Damianin 

Daturin 

Delphinin 

Dermatol 

Diaphtherin 

Diastase 

taka 

Diathesin 

Diethylketone 

Digalen 

Digitalein 

Digitalin, French 

German 

Digitalis 

Digitoxin 

Dionin 

Dioscorein 

Diosmal 

Dithion 

Diuretin 

Dormiol 

Dover's powder 

Duboisine sulphate 

Duotal (carbonate) 

Eigon, beta 

alpha-sodium 

Elaterin 

Elaterium 

Emetin alkaloid. . , 

emetic 

Emulsion, ammoniac 



Grains or minims 



Grams or Cc. 



Mo- 

10 

5 

%■ 

2 

1 

1 

2 

20 

1 

15 

15 

1 

3 

1 

15 

3 

V12 

%0 

1 

5 

Vk 



4 

y 8 

15 
4 
3 
2 
2 
15 
80 
15 
30 
30 
15 
10 
3 
60 
6 
■% 

— M 

— 3 



L2 



U 



,12 



2 — 5 

%50 — %4 

l/ an — 1 /„ 



700 



720 



4 — 8 

8 — 15 

1 — 3 

3 — 5 

8 — 15 

8 — 15 

Moo 

%4 — Me 

Mso — Veo 

1/-,^ SJL 



710 



%60 



7ZJ 



1,4 



L /120 



V4 — 1 

1 — 4 

2 — 10 

3 — 15 
15 

8 — 30 
5 — 20 

Vso — Voo 

4 — 15 

15 — 45 
15 — 45 

Vs — % 

M 20 %0 

Mo — % 
240 — 480 



0.13 - 

0.003 - 

0.6 daily 

0.3 

0.05 - 

0.13 - 

0.06 - 

0.06 - 

0.13 - 

1.25 - 

0.06 - 

1. 

1. 

0.06 - 

0.2 

0.6 

1. 

0.2 

0.005 - 

0.001 - 

0.06 - 

0.3 

0.0025 



0.13 

0.00025 

0.001 

0.25 

0.5 

0.06 

0.2 

0.5 

0.5 

0.0003 

0.001 

0.00025 

0.006 

0.06 

0.00025 

0.015 

0.06 

0.12 

0.2 

1. 

0.5 

0.3 

0.0008 

0.25 

1. 
1. 

0.003 
0.008 • 
0.0005 ■ 
0.004 
15. 



0.25 
0.008 

1. 

0.25 

0.2 

0.13 

0.13 

1. 

5. 

1. 

2. 

2. 

1. 

0.6 

0.2 

4. 

0.4 

0.01 

0.005 

0.2 



— 0.005 

- 0.3 
0.001 
0.003 
0.5 
1. 

0.2 
0.3 
1. 
1. 

0.004 

0.001 

0.03 

0.2 

0.0005 

0.06 

0.25 

0.6 

1. 

2. 
1.3 
0.003 
1. 

3. 
3. 

0.005 
0.03 
0.001 
0.008 
30. 



548 



APPENDIX. 



Remedy 



Emulsion, asafetida 

chloroform 

Enesol 

Enterin 

Ergot 

Ergotin, bombelon 

bonjean 

Erythrol tetranitrid 

Erythrophlein hydrochlorid . 

Erythroxylin 

Eserin salicylate 

Ether 

ozonized 

petroleum 

valerianic 

Ethyl bromid 

formate 

iodid 

valerianate 

Ethylen bromid 

Eucalyptol 

Eudoxin 

Eugenof orm 

Eugenol 

Eunatron 

Eumenol 

Eumydrin 

Eunatrol 

Euonymin 

Eupatorin 

Euphorbin 

Euphorin 

Eupurpurin 

Eupyrin , 

Euquinin 

Europhen 

Exalgin 

Exodin 

Extract, absinth., alcoholic 

absinth. , fluid 

achillea, alcoholic 

fluid 

aconite , 

fluid 

adhatoda, fluid 

adonis root, fluid 

vern. , aqueous 

sesculus, glab. , fluid 
hippocast. bark, fluid, 
seeds, fluid 

agrimonia, fluid 

aletris, alcoholic 

fluid 

allium, fluid 

aloes 



Grains or minims 



Grams or Cc. 



120 — 360 
60 — 120 

M 

5 — 15 

20 — 90 

30 — 90 

3 — 10 



V-2 
1 , 



' I 



1 , 



' 1 20 

10 

30 

2 

1 

*5 

60 

5 

1 

1 

4 

5 

5 

8 

4 

60 

%o 

10 

i 

y 4 

8 

1 

15 

% 
% 

2 
15 

5 
20 

5 
30 
% 
%■ 
15 

v-2 

10 
20 
10 
20 

%■ 

30 

30 

1 



1 

Me 
1 

40 

60 

10 

2 

10 

120 

15 

2 

2 

12 

15 

15 

30 

8 



— U 



Y2± 

15 

6 

3 

3 

15 

4 

30 

2 

Vk 

5 

45 

20 

60 

20 

60 

V-2 
1 

60 

5 

1 

20 

60 

30 

60 

3 

60 

60 



8. 

4. 

0.01 

0.3 

1JB 

2. 

0.2 

0.03 

0.002 

0.015 

0.0005 

0.6 

2. 

0.12 

0.06 

0.3 

4. 

0.3 

0.06 

0.06 

0.25 

0.3 

0.3 

0.5 

0.25 

4. 

0.001 

0.6 

0.1 

0.06 

0.015 

0.5 

0.06 

1. 

0.03 

0.03 

0.13 

1. 

0.3 

1.3 

0.3 

2. 

0.015 

0.015 

1. 

0.03 

0.01 

0.6 

1.3 

0.6 

1.3 

0.03 

2. 

2. 

0.06 



24. 
8. 

1. 

6. 

6. 

0.6 

0.06 

0.004 

0.06 

0.002 

2.5 

4. 

0.6 

0.12 

0.6 

■ 8. 
1. 

0.13 
0.13 
0.8 
1. 

1. 
2. 
0.5 

0.0025 
1. 

■ 0.4 
0.02 
0.2 
1. 

0.25 
2. 

• 0.13 

• 0.1 ' 
0.3 

• 3. 

■ 1.3 

■ 4. 

• 1.3 

■ 4. 
0.03 
0.06 

• 4. 
0.3 
0.06 
1.3 

■ 4. 

• 2. 

■ 4. 

• 0.2 
4. 

• 4. 

■ 0.4 



* 2Yz — 5 fluidrams (10 — 20 Cc.) as inhalation anesthetic. 



DOSE TABLE. 



549 



Remedy 



Extract, aloes, fluid 

alstonia, fluid 

althea, fluid 

alnus serrul. , fluid 

ampelopsis, fluid 

anemone hepat., fluid 

angelica root, fluid 

seed, fluid 

anise, fluid 

anthemis, aqueous 

fluid 

apium, alcoholic 

fluid 

aplopappus, fluid 

apocynum, fluid 

androsaemifol, fluid 

cannab. , alcoholic 

apple, ferrated 

aralia. , hisp. , fluid 

racem. , fluid 

arctostaph, glauca, fluid. . . . 

areca, fluid 

ailanthus, fluid 

arnica flowers 

fluid 

arnica root 

fluid 

artemis, abrotan, fluid 

frig. , fluid 

vulg 

fluid 

asafetida, fluid 

asarum, fluid 

ascep. syriaca, fluid 

curassav. , fluid 

incarn. , fluid 

asparagus, fluid 

aspidium, fluid 

aspidosperma, fluid 

aurant, amar. , alcoholic 

baptisia, fluid 

belladonna, leaves, alcoholic 

aqueous, dry 

fluid 

berberis, aquif., alcoholic. . . 

fluid 

vulg. , fluid 

blackberry, aqueous 

fluid 

black haw, fluid 

boldo, fluid 

borage, fluid 

brunf elsia, fluid 

bryonia, alcoholic 

fluid 

buchu, alcoholic 



Grains or minims 


Grams or Cc. 


10 — 30 


0.6 


— 2. 


30 — 60 


2. 


— 4. 


30 — 60 


2. 


— 4. 


30 — 60 


2. 


— 4. 


5 — 20 


0.3 


— 1.3 


30 — 60 


2. 


— 4. 


30 — 60 


2. 


— 4. 


30 — 60 


2. 


— 4. 


30 — 60 


2. 


— 4. 


3 — 15 


0.2 


— 1. 


30 — 60 


2. 


— 4. 


10 — 20 


0.6 


— 1.3 


60 — 120 


4. 


— 8. 


8 — 15 


0.5 


— 1. 


5 — 20 


0.3 


— 1.3 


5 — 30 


0.3 


— 2. 


1 — 4 


0.06 


— 0.25 


3 — 15 


0.2 


— 1. 


30 — 60 


2. 


— 4. 


30 — 60 


2. 


— 4. 


20 — 60 


1.3 


— 4. 


45 — 120 


3. 


— 8. 


10 — 30 


0.6 


— 2. 


3 — 10 


0.2 


— 0.6 


5 — 30 


0.3 


— 2. 


1 — 2 


0.06 


— 0.13 


5 — 10 


0.3 


— 0.6 


30 — 60 


2. 


— 4. 


60 — 120 


4. 


— 8. 


2 — 10 


0.13 


— 0.6 


30 — 60 


2. 


— 4. 


5 — 20 


0.3 


— 1.3 


15 — 60 


1. 


— 4. 


30 — 60 


2. 


— 4. 


60 — 120 


4. 


— 8. 


30 — 60 


2. 


— 4. 


30 — 60 


2. 


— 4. 


60 — 240 


4. 


— 15. 


30 — 60 


2. 


— 4. 


2 — 10 


0.13 


— 0.6 


10 — 60 


f 0.6 


— 4. 


%'— % 


0.008 


— 0.03 


li — l 


0.015 


— 0.06 


2 — 6 


0.13 


— 0.4 


2 — 6 


0.13 


— 0.4 


10 — 30 


0.6 


— 2. 


30 — 60 


2. 


— 4. 


5 — 10 


0.3 


— 0.6 


30 — 60 


2. 


— 4. 


30 — 60 


2. 


— 4. 


4 — 8 


0.25 


— 0.5 


30 — 60 


2. 


— 4, 


5 — 20 


0.3 


— 1.3 


2 — 6 


0.13 


— 0.4 


20 — 60 


1.3 


— 4. 


5 — 10 


0.3 


— 0.6 



550 



APPENDIX. 



Remedy 



Grains or Minims 



Extract, buchu, alcoholic, fluid . 

comp 

buckthorn berries, fluid 

burdock, fluid 

calamus, dry 

fluid 

calendula, alcoholic 

fluid 

calumba, alcoholic 

dry 

fluid 

calycanthus, fluid 

canella, fluid 

cannab. indicus 

fluid! 

capsella, fluid 

capsicum 

fluid 

caraway, fluid 

cardenia, aqueous, dry 

fluid. 

carthamus, fluid 

carum copt. , fluid 

caryoph, fluid 

cascara, amarga 

sagr 

fluid 

cascarilla, alcoholic 

fluid 

castanea, fluid 

catechu, aqueous, dry 

fluid 

caulophyllum, alcoholic 

fluid 

celastrus, fluid 

cephalanthus, fluid 

cercis, fluid 

cereus grandiflora, fluid 

chamaelirium, fluid 

chelidonium, alcoholic 

fluid 

chenopodium, fluid 

chimaphila, fluid 

chionanthus 

fluid 

chirata, fluid 

chrysanthemum, fluid 

chrysophyllum, aqueous, dry 

cicorium 

cicuta, fluid 

cimicifuga 

fluid 

cinchona 

fluid 

cinch, calis. , alcoholic, dry . . 
cinnamon, fluid 



i ; 



15 — 60 
20 — 60 
30 — 60 
30 — 60 

2 — 6 
15 — 60 

2 — 6 
15 — 60 

4 — 20 
2 — 10 

5 — 20 
30 — 60 
15 — 60 
3 i — 1 

2 — 5 

15 — 150 

in — U« 

1 — 5 
30 — 60 

5 — 10 
30 — 60 

16 — 60 
10 — 30 

5 — 10 
30 — 60 

5 — 20 
15 — 60 

2 — 6 
15 — 45 
60 — 120 

5 — 20 
SO — 120 

2 — 5 
10 — 30 
30 — 60 
30 — 60 
15 — 60 

3 — 10 
30 — 60 

5 — 20 
15 — 60 
30 — 60. 
30 — 60 

3 — 10 
30 — 60 
10 — 30 
30 — 60 

2 — 5 
20 — 40 

1 — 5 

2 — 6 
15 — 45 

1 — 10 
5 — 15 

2 — 5 
10 — 30 



Grams or Cc. 



1. 

1.3 

2. 

2. 

0.13 

1.' 

0.13 

1. 

0.25 

0.13 

0.3 

2. 

1. 

0.015 

0.13 

1. 

0.006 

0.06 

2. 

0.3 

2. 

1. 

0.6 

0.3. 

2. 

0.3 

1. 

0.13 

1. 

4. 

0.3 

2. 

0.13 

0.6 

2. 

2. 

1. 

0.2 

2. 

0.3 

1. 

2. 

2. 

0.2 

2. 

0.6 

2. 

0.13 

1.3 

0.06 

0.13 

1. 

0.06 

0.3 

0.13 

0.6 



4. 
4. 
4. 
4. 
0.4 
4. 
0.4 
4. 
1.3 
0.6 
1.3 
4. 
4. 

0.06 
0.3 
10. 
0.03 
0.3 
4. 
0.6 
4. 
4. 
2. 

0.6 
4. 
1.3 
4. 
0.4 
3. 
8. 
1.3 
8. 
0.3 
2. 
4. 
4. 
4. 
0.6 
4. 
1.3 
4. 
4. 
4. 
0.6 
4. 
2. 
4. 
0.3 
2.5 
0.3 
0.4 
3. 
0.6 
1. 

0.3 
2. 



DOSE TABLE. 



551 



Remedy- 



Extract, citrullus valg. , fluid. 
coca, alcoholic, dry 

fluid 

cocblearia, fluid 

officio 

coffee (green) , alcoholic . 

(green), fluid 

(roasted), fluid 

cola, alcoholic, dry 

fluid 

colchicum seed, acetic. . . . 

fluid 

collinsonia. 

fluid 

colocynth 

compound 

fluid 



comum 

fluid 

leaves, fluid 

convallaria, alcoholic. . . 

fluid 

flowers, fluid 

corallorhiza, fluid 

coriander, fluid 

cornus flor 

fluid 

coto 

crocus, alcoholic 

cubeb 

fluid , 

curcuma, alcoholic 

fluid 

cusparia, fluid 

cynoglossum, aqueous. . 

fluid 

cyperus, fluid. 

cypripedium 

fluid 

delphin. consolida, fluid 
digitalis 

alcoholic, dry , 

fluid 

dioscorea, fluid , 

diospyros, fluid , 

drosera 

fluid 

duboisia 

fluid : 

dulcamara, alcoholic 

fluid 

echinacea, fluid 

elephantopus, fluid 

embelia, fluid 

ephedra, fluid 

epifagus, fluid 



Grains or minims 


Grams or Cc. 


60 — 120 


4. 


— 8. 


4 — 15 


0.25 


— 1. 


20 — 60 


1.3 


— 4. 


30 — 60 


2. 


— 4. 


8 — 30 


0.5 


— 2. 


3 — 10 


0.2 


— 0.6 


20 — 60 


1.3 


— 4. 


20 — 60 


1.3 


— 4. 


2 — 5 


0.13 


— 0.3 


15 — 60 


1. 


— 4. 


1 — 3 


0.06 


— 0.2 


3 — 10 


0.2 


— 0.6 


4 — 10 


0.25 


— 0.6 


20 — 60 


1.3 


— 4. 


1 — 3 


0.06 


— 0.2 


3 — 10 


0.2 


— 0.6 


5 — 10 


0.3 


— 0.6 


Y2 — 2 


0.03 


— 0.13 


2 — 5 


0.13 


— 0.3 


2 — 5 


0.13 


— 0.3 


1—4 


0.06 


— 0.25 


15 — 30 


1. 


— 2. 


5 — 15 


0.3 


— 1. 


30 — 60 


2. 


— 4. 


20 — 60 


1.3 


— 4. 


5 — 10 


0.3 


— 0.6 


30 — 60 


2. 


— 4. 


5 — 15 


0.3 


— 1. 


2 — 6 


0.13 


— 0.4 


2 — 10 


0.13 


— 0.6 


15 — 60 


1. 


— 4. 


1 — 5 


0.06 


— 0.3 


10 — 30 


0.6 


— 2. 


10 — 30 


0.6 


— 2. 


1 — 5 


0.06 


— 0.3 


10 — 30 


0.6 


— 2. 


10 — 30 


0.6 


— 2. 


2 — 5 


0.13 


— 0.3 


15 — 30 


1. 


— 2. 


1 — 5 


0.06 


— 0.3 


% — V2 


0.015 


— 0.03 


% — 1 


0.01 


— 0.06 


1 — 3 


0.06 


— 0.2 


15 — 60 


1. 


— 4. 


30 — 60 


2. 


— 4. 


1 — 3 


0.06 


— 0.2 


5 — 20 


0.3 


— 1.3 


% — 1 


0.015 


— 0.06 


5 — 10 


0.3 


— 0.6 


5 — 20 


0.3 


— 1.3 


30 — 120 


2. 


— 8. 


30 — 60 


2. 


— 4. 


5 — 30 


0.3 


— 2. 


60 — 240 


4. 


— 15. 


60 — 120 


4. 


— 8. 


30 — 60 


2. 


— 4. 



552 



APPENDIX. 



Remedy- 



Extract, epigaea, fluid 

epilobium, fluid 

equisetum, fluid 

ergot 

fluid 

erigeron, fluid 

eriodictyon, fluid 

alcoholic 

erythraea, aqueous 

ery throphleum, fluid 

eucalyptus, alcoholic, dry 

fluid 

seed, alcoholic 

fluid 

euonymus 

fluid 

eupatorium, fluid 

eupator, perf ol 

eupator. purpur 

fluid 

euphorb. coroll. , fluid .... 
euphorb. pilulif. , fluid . . . 

fennel, fluid 

frangula, aqueous, dry.. . 

fluid 

frankenia, fluid 

f raxinus americ. , fluid . . . 

f rax. sambucif . , fluid 

f ucus, dry 

fluid 

fumaria, aqueous 

galega, aqueous 

galium aparine, fluid 

galium ver. , fluid 

garcinia 

fluid 

gaultheria, fluid 

gelsemium, alcoholic, dry 

fluid 

gentian 

fluid 

gentian, fluid, co 

quinquefl. , fluid 

geranium 

fluid 

gossypium, alcoholic, dry 

fluid 

gouania, fluid 

granatum, alcoholic, dry. 

(tenif uge) 

fluid 

(tenifuge) 

grindelia, aqueous 

fluid 

guaco, fluid 

guaiac 



Grains or minims 



30 
30 
30 

5 

30 
30 
20 

4 

5 

5 

1 

5 

10 
60 

2 
15 
20 

4 

5 
30 

5 
30 
30 

3 
15 
10 
20 
30 

1 

10 
10 

8- 
30 
30 

1 

15 
30 
V±- 

2 

2 
10 
10- 
30 

5 
30 

3- 
30- 
60- 

5- 

30- 

15- 

240- 

3- 
20- 
30- 

3- 



-60 

-60 

-60 

-15 

-120 

-60 

-60 

-12 

-30 

-15 

-3 

-20 

-40 

-240 

-5 

-60 

-60 

-10 

-10 

-60. 

-30 

-60 

-60 

■10 

-30 

-20 

-40 

■60 

-5 

•30 

-60 

-15 

•60 

•60 

2 
•60 

60 

% 

5 

6 

30 

30 

60 

10 

60 

10 

60 

120 

10 

90 

60 

720 

10 

60 

60 

10 



Grams or Cc. 



2. 
2. 
2. 

0.3 
2. 

2. - 
1.3 
0.25 
0.3 
0.3 
0.06 
0.3 
0.6 
4. 

0.13 
1. 
1.3 
0.25 
0.3 
2. 
0.3 
2. 
2. 
0.2 
1. 
0.6 
1.3 
2. 

0.06 
0.6 
0.6 
0.5 
2. 
2. 

0.06 
1. 
2. 

0.015 
0.13 
0.13 
0.6 
0.6 
2. 
0.3 
2. 
0.2 
2. 
4. 
0.3 
2. 
1. 
15. 
0.2 
1.3 
2. 
0.2 



— 4. 

— 4. 

— 4. 

— 1. 

— 8. 

— 4. 

— 4. 

— 0.8 

— 2. 

— 1. 

— 0.2 

— 1.3 

— 2.5 

— 15. 

— 0.3 

— 4. 

— 4. 

— 0.6 

— 0.6 

— 4. 

— 2. 

— 4. 

— 4. 

— 0.6 

— 2. 

— 1.3 

— 2.5 

— 4. 

— 0.3 

— 2. 

— 4. 

— 1. 

— 4. 

— 4. 

— 0.13 

— 4. 

— 4. 

— 0.03 

— 0.3 

— 0.4 

— 2. 

— 2. 

— 4. 

— 0.6 

— 4. 

— 0.6 

— 4. 

— 8. 

— 0.6 

— 6. 

— 4. 

— 45. 

— 0.6 

— 4. 

— 4. 

— 0.6 



DOSE TABLE. 



553 



Remedy 



Extract, guaiac, fluid 

guarana, dry 

fluid . 

hamamelis, alcoholic, dry 

fluid . 

hedeoma, fluid 

helianth, fluid 

hellebor, niger 

niger, fluid 

vir 

hematoxylon 

humulus, fluid 

alcoholic 

aqueous 

hydrangea, fluid 

hydrastis 

fluid 

hyoscyamus 

leaves 

seed, dry 

fluid 

ignatia, alcoholic, dry . . . 

fluid 

iris „ 

fluid 1 . 

jaborandi, fluid 

jalap 

kamala, fluid 

kava-kava 

fluid 

kino, fluid 

kousso, alcoholic 

fluid 

krameria 

alcoholic 

fluid 

lactucarium 

lactuca, alcoholic 

laetuc, can 

lactucar, fluid 

lappa, alcoholic 

fluid 

leptandra 

fluid 

levisticum, fluid 

lobelia 

fluid 

seed, fluid 

lupulin, fluid 

lycop. europ. , fluid , 

magnolia, fluid , 

male f ern=oleores 

malt 

dry 

marrubium 

fluid 



Grains or minims 



30 — 120 

2 — 5 
15 — 60 

3 — 10 
15 — 60 
15 — 60 
30 — 60 

v 2 — m 

30 — 60 

2 — 5 

10 — 20 

30 — 60 

2 — 5 

4 — 10 
30 — 60 

3 — 10 
10 — 30 

1 — 3 

1 — 2 

% — 1 

5 — 15 
% — % 

1 — 4 

2 — 6 
10 — 30 
10 — 30 

2 — 5 
60 — 120 

3 — 10 
15 — 60 
10 — 30 
30 — 60 
60 — 240 

2 — 10 

5 — 15 

15 — 60 

2 — 10 
%— 2 
10 — 30 
10 — 60 

4 — 8 
30 — 60 

3 — 10 
20 — 60 
15 — 60 
V 2 — 2 

2 — 10 

2 — 10 
10 — 20 
30 — 60 
30 — 60 

120 — 240 
240 
60 — 240 

3 — 10 
30 — 120 



Grams or Cc. 



2. 

0.13 
1. 

0.2 
1. 
1. 
2. 

0.03 
2. 

0.13 
0.6 
2. 

0.13 
0.25 
2. 
0.2 
0.6 
0.06 
0.06 
0.03 
0.3 
0.008 
0.06 
0.13 
0.6 
0.6 
0.13 
4. 
0.2 
1. 

0.6 
2. 
4. 

0.13 
0.3 
1. 

0.13 
0.03 
0.6 
0.6 
0.25 
2. 
0.2 
1.3 
1. 

0.03 
0.13 
0.13 
0.6 
2. 
2. 
8. 
15. 
4. 
0.2 
2. 



0.3 

4. 

0.6 

4. 

4. 

4. 

0.1 

4. 



- 0.3 

- 1.3 

- 4. 

- 0.3 

■ 0.6 

- 4. 

- 0.6 

- 2. 

- 0.2 

- 0.13 

- 0.06 

- 1. 

- 0.3 

- 0.25 

- 0.4 

- 2. 

■ 2. 

• 0.3 

• 8. 

• 0.6 

• 4. 

■ 2. 

• 4. 
•15. 

• 0.6 

• 1. 

• 4. 

• 0.6 

• 0.13 

■ 2. 

■ 4. 
0.5 

■ 4. 

■ 0.6 

■ 4. 

• 4. 
0.13 
0.6 
0.6 
1.3 
4. 

4. 
15. 

15. 
0.6 



554 



APPENDIX. 



Remedy- 



Grains or minims 



Extract, matico, alcoholic 
fluid 

matricaria, alcoholic. . 
fluid 

melia, fluid 

melissa, fluid 

menispermum, fluid. . . 

mezereum, dry ....... 

michella, fluid 

monarda, fluid 

monesia 

myristica, fluid 

myrrh, fluid 

naregamia, fluid 

nepeta, fluid 

nicotiana, alcoholic . . . 
fluid 



nux vomica 

fluid 

nymphae, fluid 

Oenothera, fluid 

opium 

aqueous 

papaver, alcoholic 

fluid 

pareira, fluid 

parsley, root 

seed, fluid 

passiflora, fluid 

phellandrium, alcoholic 
physostigma 

fluid 

Phytolacca berries 

root 

fluid 

pichi (fabiana) 

fluid 

pilcarpus, dry 

fluid 

pimentia, fluid 

pimpinella 

fluid 

pinus strob, fluid 

pinus sylvest 

piper jabor, fluid 

methyst. 

nigra 

fluid 

podophyllum 

fluid 

polyporus, fluid 

polytrichum, fluid. ..... 

pomegran. , fluid 

populus balsam 

nigra 

prunus virg., fluid. 



5 
30 

2 
15 
10 
60 
30 

1 
30 
15 

2 

5 
10 

1 

30 

Mo 

Vs. 

%■ 

1 
15 
30 
hi 

1 

10 
30 
30 
30 
10 
2 

Vl2 
1 

5 

%• 

1 

3 
15 

2 
10 
10 

5 
20 
30 

3 
10- 

3 

2- 
10 

2 
10 

2 
20- 
60 
30 

3 
20 



10 

■60 

-8 

60 

30 

•120 

60 

3 

60 

■60 

5 

20 
30 
2 

120 
1 
5 

■Va 
5 

60 
60 
1 
1 
4 
30 
60 
120 
60 
30 
5 
% 
3 
15 
1 
5 

12 
60 
5 

30 
40 
15 
60 
60 
6 

30 
10. 
8 

40 
5 

30 
15- 
60 
120 
60 
10 
60 



Grams or Cc. 



0.3 

2. 

0.13 

1. 

0.6 

4. r 

2. 

0.06 

2. 

1. 

0.13 

0.3 

0.6 

0.06 

2. 

0.006 

0.03 

0.008 

0.06 

1. 

2. 

0.015 

0.015 

0.06 

0.6 

2. 

2. 

2. 

0.6 

0.13 

0.005 

0.06 

0.3 

0.015 

0.06 

0.2 

1. 

0.13 

0.6 

0.6 

0.3 

1.3 

2. 

0.2 

0.6 

0.2 

0.13 

0.6 

0.13 

0.6 

0.13 

1.3 

4. 

2. 

0.2 

1.3 



0.6 

4. 

0.5 

4. 

2. 

8. 

4. 

0.2 

4. 

4. 

0.3 

1.3 

2. 

0.13 

8. 

0.06 

0.3 

0.03 

0.3 

4. 

4. 

0.06 

0.06 

0.25 

2. 

4. 



4. 

2. 

0.3 

0.015 

0.2 

1. 

0.06 

0.3 

0.8 

4. 

0.3 

2. 

2.5 

1. 

4. 

4. 

0.4 

2. 

0.6 

0.5 

5 

3 



DOSE TABLE, 



555 



Remedy- 



Grains or minims 



Extract, ptelea, fluid 

pulmonaria, fluid 

Pulsatilla 

fluid 

pyrethrum 

pyrus, fluid 

quassia, alcoholic, dry . . 

aqueous, dry 

fluid 

quebracho, dry 

quercus 

quillaja 

rhamnus, cath. , fluid . . . 

frang 

pursh 

rhododendron, fluid 

rhubarb 

(laxative) 

(purgative) 

fluid 

dry 

fluid, arom 

and senna, fluid ....... 

rhus arom. , fluid 

glabra, fluid 

radicans, fluid 

ricinus, leaves . : 

seed, fluid 

rose, fluid 

rubia, aqueous 

rubus, fluid 

strig. , fluid 

villos, aqueous 

villos, fluid 

rumex acetos 

crisp 

crisp, fluid 

ruta, alcoholic 

fluid 

sabadilla, fluid 

sabbatia angul. , fluid . . . 

sage, fluid 

salix alb., fluid 

salix nigr. bark, fluid. . . 

buds, fluid 

sambucus, fluid 

sanguinaria, aqueous . . . 

emetic 

fluid 

santonica, alcoholic 

saponaria, alcoholic 

fluid 

sarsapar. , alcoholic, dry 

co., fluid 

fluid 

sassafras, aqueous 



15 — 30 
30 — 60 
% — 1 
2 — 5 
30 — 60 
60 — 120 

1 — 5 

2 — 5 
10 — 30 

2 — 5 

3 — 10 

2 — 5 
30 — 60 

3 — 10 

5 — 20 
30 — 60 

1 — 3 
3 — 6 

6 — 10 
5 — 30 
1 — 10 

10 — 60 
30 — 60 
15 — 60 
30 — 60 
1 — 5 
30 — 60 
10 — 30 
30 — 60 



3 
30 
10 

5 
30 

5 

3 



10 
60 
60 
10 
60 
10 
10 



15 — 60 

2 — 5 
15 — 30 

5 — 15 
30 — 60 
15 — 60 
30 — 60 

5 — 60 
30 — 60 
30 — 120 



i;. 



i., 



76 — 73 
1V2 — 3 

3 — 20 

2 — 5 

8 — 20 

40 — 120 

5 — 20 

30 — 120 

30 — 120 

2 — 8 



Grams or Cc. 



1. 

2. 

0.015 

0.13 

2. 

4. 

0.06 

0.13 

0.6 

0.13 

0.2 

0.13 

2. 

0.2 

0.3 

2. 

0.06 

0.2 

0.4 

0.3 

0.06 

0.6 

2. 

1. 

2. 

0.06 

2. 

0.6 

2. 

0.2 

2. 

0.6 

0.3 

2. 

0.3 

0.2 

1. 

0.13 

1. 

0.3 

2. 

1. 

2. 

0.3 

2. 

2. 

0.01 

0.1 

0.2 

0.13 

0.5 

2.5 

0.3 

2. 

2. 

0.13 



2. 

4. 

0.06 

0.3 

4. 



— 0. 

— 0. 

— 0. 

— 0. 

— 0. 

— 0. 

— 4. 

— 0.6 

— 1.3 

— 4. 

— 0.2 

— 0.4 

— 0.6 

— 2. 

— 0.6 

— 4. 

— 4. 

— 4. 

— 4. 

— 0.3 

— 4. 

— 2. . 

— 4. 

— 0.6 

— 4. 

— 4. 

— 0.6 

— 4. 

— 0.6 

— 0.6 

— 4. 

— 0.3 

— 2. 

— 1. 

— 4. 

— 4. 

— 4. 

— 4. 

— 4. 

— 8. 

— 0.02 

— 0.2 

— 1.3 

— 0.3 

— 1.3 

— 8. 

— 1.3 



— 0.5 



556 



APPENDIX. 



Remedy 



Extract, sassafras, fluid 

satureja, fluid 

savine, alcoholic 

fluid 

scoparius, fluid 

scopolia, fluid 

Scutellaria 

fluid 

senecio 

fluid 

senega, alcoholic, dry 

fluid 

senna, alcoholic 

fluid.... 

serpentaria 

fluid 

sesamum, fluid 

solidago odor, fluid 

solidago virg. , fluid 

sorghum, fluid 

spigelia co. , fluid 

spigelia, fluid 

spigelia and senna, fluid 

spiraea, fluid 

squill co. , fluid 

squill, fluid 

stachys, fluid 

•statice, fluid 

stillingia , 

fluid 

fluid co 

stramonium leaves, alcoholic, dry 

fluid 

stramonium seed 

fluid 

strophanthus 

fluid 

strychn. malac. , fluid 

stylosanthes, fluid 

sumbul 

fluid 

sycocarpus, fluid 

Symphytum, fluid 

symplocarpus, fluid 

tansy, fluid 

taraxacum 

fluid 

teucrium, fluid 

thapsia, fluid 

thuja, fluid 

thymus, fluid 

tonga, fluid 

tormentilla, dry 

fluid 

trillium, fluid 

triticum, aqueous 



Grains or minims 



30- 
30- 

y 2 . 

5- 
30- 

1- 

5- 
30- 

2- 
10- 

1- 

5- 
10- 
60- 

1- 
10- 

1- 
30- 
30- 
30- 
90 
60- 
90 
30- 

2 

1 
30- 
10- 

3- 
15- 
30 
%• 

1 

% 
i 

%■ 

10 
10 

2 
20 
10 
30 
10 
30 
10 
60 
30 

2 
30 

5 
10 

5 
30 
60 



60 
60 
2 

20 
60 
3 
10 
60 
10 
60 
3 

20 
40 
240 
5 

30 
10 
60 
60 
60 
180 
120 
180 
60 
15 
3 

•60 

30 

10 

•60 

-90 

1 

3 

- i/> 

-3~ 
-Wa 

-l/o 

30 
-20 
-5 
-60 
-30 
-60 
-20 
-60 
-30 
-120 
-60 
-10 
-60 
-30 
-30 
-15 
-60 
-120 
-30 



Grams or Cc. 



2. 

2. 

0.03 

0.3 

2. 

0.06 

0.3 

2. 

0.13 

0.6 

0.06 

0.3 

0.6 

4. 

0.06 

0.6 

0.06 

2. 

2. 

2. 

6. 

4. 

6. 

2. 

0.13 

0.06 

2. 

0.6 

0.2 

1. 

2. 

0.015 

0.06 

0.015 

0.06 

0.001 

0.008 

0.06 

0.6 

0.2 

1.3 

0.6 

2. 

0.6 

2. 

0.6 

4. 

2. 

0.13 

2. 

0.3 

0.6 

0.3 

2. 

4. 

0.5 



4. 

4. 

0.13 

1.3 

4. 

0.2 

0.6 

4. 

0.6 

4. 

0.2 

1.3 

2.5 
15. 

0.3 

2. 

0.6 

4. 

4. 

4. 
12. 

8. 
12. 

4. 

1. 

0. 

4. 

2. 

0.6 

4. 

6. 

0.06 

0.2 

0.03 

0.2 

0.004 

0.03 

2. 

1.3 

0.3 

4. 

2. 

4. 

1. 

4. 

2. 



— 0.2 



— 1.3 



4. 

0.6 

4. 

2. 

2. 

1. 

4. 

8. 

2. 



IpqggHMHBBHiHHHHHHlMlHIHHMHiaB 



■N 



■H^Hfl^HHMHHHHHI^^H^HHH^l^Hi 






DOSE TABLE. 



557 



Remedy 




Grams or Cc. 



Extract, triticum, aqueous, fluid 60 — 240 

turnera 5 — 20 

fluid 60 — 120 

tustilago, fluid 30 — 60 

urechites, fluid 2 — 10 

urtica, fluid 15 — 30 

uva ursi 5 — 15 

fluid 60 — 120 

vaccinium, fluid 30 — 60 

valerian, alcoholic 5 — 15 

fluid 10 — 30 

veratr. vir ' i — 1 

fluid 1 — 4 

verbascum, fluid 30 — 60 

verbena, fluid 10 — 30 

viburn. opul. , fluid 30 — 60 

viburn, prun. , alcoholic, dry 5 — 15 

fluid 15 — 60 

viola, fluid 30 — 60 

wild cherry, fluid 20 — 60 

white oak, fluid 30 — 60 

xanthium spin. , fluid 60 — 120 

xanthium strum. , fluid 60 — 120 

xanthoxylum 5 — 10 

fluid 15 — 60 

berries, fluid 20 — 10 

zea, fluid 30 — 90 

Feralboid & — 1 

Ferratin. , 4 — 8 

Ferratogen 5 — 8 

Ferrinol 3 — 5 

Ferropyrin 5 — 15 

Ferrostyptin 5 — 10 

Fluoroformol (fluorol) 240 

Formanilid I 2 — 4 

Formin 8 — 15 

Fowler's solution 1 — 5 

Fraserin 1 — 3 

Fuchsin ' f 2 — 3 

Gaduol 5 — 30 

Gaiacophosphal 2 — 15 

Gallogen I 5 — 15 

Galbanum < 10 — 20 

Gall, ox, inspiss ' 2 — 5 

Gallobromol 10 — 30 

Gamboge 1 — 5 

Geissospermin 8 — 30 

Gelseminin M20 — hko 

Gentian 10 — 30 

Geosote 3 — 10 

Geraniin J 1 — 3 

Gillenin ' 4 — 6 

Ginger 5 — 20 

Globon 30 — 60 



4. 

0.3 

4. 

2. 

0.13 

1. 

0.3 

4. 

2. 

0.3 

0.6 

0.015 

0.06 

2. 

0.6 

2. 

0.3 

1. 

2. 

1.3 

2. 

4. 

4. 

0.3 

1. 

1.3 

2. 



15. 
1.3 

8. 

4. 

0.6 

2. 

1. 

8. 

4. 

1. 

2. 

0.06 

0.25 

4. 

2. 

4. 

1. 

4. 

4. 

4. 

4. 



0.6 
4. 
2.5 
6. 



0.02 


— 0.06 


0.25 


— 0.5 


0.3 


— 0.5 


0.2 


— 0.3 


0.3 


— 1. 


0.3 


— 0.6 


15. 




0.13 


— 0.25 


0.5 


— 1. 


0.06 


— 0.3 


0.06 


— 0.2 


0.03 


— 0.2 


0.3 


— 2. 


0.13 


— 1. 


0.3 


— 1. 


0.6 


— 1.3 


0.13 


— 0.3 


0.6 


— 2. 


0.06 


— 0.3 


0.5 


— 2. 


0.0005 


— 0.002 


0.6 


— 2. 


0.2 


— 0.6 


0.06 


— 0.2 


0.25 


— 0.4 


0.3 


— 1.3 


2. 


— 4. 



558 



APPENDIX. 



Remedy 



Grains or minims' 



Grams or Cc. 



Gluside 

Glycerin 

Glycerite, acid carbolic 

acid gallic 

acid tannic 

tar 

Glycogenol 

Glycyrrhizin 

Gold and potassium bromid. 

and sodium chlorid 

arsenite 

bromid 

cyanid 

chlorid 

iodid 

oxid 

and sod. brom 

Gomenol 

Gonosan 

Gossypiin 

Griserin 

Guaiac 

Guaiacetin 

Guaiacol 

phosphate 

Guaiacyl 

Guaiamar 

Guaiaquin 

Guaiperol 

Guaranin 

Guarana 

Guethol 

Gujasanol 



Hamamelin , 

Hashishin 

Hedonol 

Helenin 

Helicina 

Heliotropin 

Helleborein 

Helonin 

Helmitol 

Hemalbumin 

Hemogallol 

Hemoglobin 

Hemol 

Heparaden 

Heroin 

hydrochlorid . 

Hetralin , 

Histosan 

Hopagan 

Hydracetin 

Hydragogin 
Hydrastin 



1- 
60 

5 
20 
20 
60 

5 

5 

Mi 

^, n . 

fto — 

too — 
Vte — 
too- 

Is 

4 

5 

1 

5 

5 

8 

2 

5 
to 

3 

5 
10 

1 
15 

5 
15 



5 

240 

20 

60 

60 

120 

10 

15 

-.-, 

V, 

Ha 

too 
tos 
to 

\'a 

1.. 

8~ 

15 

5 

8 

15 

30 

15 

10 

Vh 

15 

10 

30 

5 

60 

10 

30 



1 — 3 
% daily 
15 — 30 

],._!, 

2 — 10 
15 

1 ,-. — K 



J c 



1 :', 



2 — 5 

15 

15 — 30 

4 — 8 

20 — 40 

2 — 8 

30 

% 2 — Ye 

Yi2—y« 

8 — 24 
60 — 240 

2 — 7 
1 i — 1 

8 — 15 
%— 1 



0.06 
4. 
0.3 

1.3 — 

1.3. — 

4. — 

0.3 — 

0.3 — 

0.001 — 

0.0025 — 

0.001 — 

0.003 — 

0.003 — 

0.0012 — 

0.001 — 

0.003 — 

0.008 — 

0.25 — 

0.3 — 

0.06 — 

0.3 — 

0.3 — 

0.5 — 

0.13 — 

0.3 — 

0.03 — 

0.2 — 

0.3 — 

0.6 — 

0.06 — 

1. — 

0.3 — 

1. — 

0.06 — 

0.05 daily 

1. — 

0.01 — 

0.12 — 

1. 

0.01 — 

0.13 — 

1. 

1. — 

0.25 — 

1.25 — 

0.13 — 

2. 

0.005 — 

0.005 — 

0.5 

4. 

0.12 

0.015 

0.5 

0.015 



0.3 
15. 
1.3 
4. 
4. 
8. 
0.6 
1. 

0.04 
0.01 
0.005 
0.012 
0.006 
0.004 
0.008 
0.015 
0.03 
0.5 
1. 

0.3 
0.5 
1. 
2. 
1. 

0.6 
0.1 
1. 
0.6 
2. 
0.3 
4. 
0.6 
2. 



2. 

0.03 

0.6 

0.02 
0.3 

2. 
0.5 
2.5 
0.5 

0.01 
0.01 

15. 

15. 
0.4 
0.06 
1. 
0.06 



DOSE TABLE. 



559 



Remedy 



Hydrohydrastinin. . . . 

Hydroquinon 

Hyoscin 

Hyoscyamin, amorph 

cryst 

Hypnacetin 

Hypnal 

Hypnon 



Ichthalbin 

Ichthoform. . . . 

Ichthyol 

Infus. digitalis 

Ingluvin 

Inulin 

Iodalbacid 
Iodantipyrin . . . 
Iodgelatin 

Iodin 

trichlorid. . 



vasogen 

Iodipin, 10 percent. . . 
Iodipin, 25 percent.. . 

Iodocaffein 

Iodoform 

Iodof ormogen 

Iodohemol 

Iodol 

Iodomuth 

Iodophenin 

Iodopyrin 

Iodosin 

Iodothein 

Iodotheobromin 

Iodothyrin 

Iodovasogen 

Ipecac 

emetic 

Iquinin 

Iridin 

Irisin 

Iron, acetate 

albuminate, dry 

pepton 

sacch 

alginate 

arsenate 

benzoate 

bromid, ferric . . 
ferric, sacch. . 
ferrous 

bromo-iodid 

cacodylate 

camphorate .... 

carbonate 



Grains or minims 



Grams or Cc. 



U — % 

5 — 15 
* Y200 — VlOO 

l/ c Va 



78 — 74 
7128 Vs-2 

3 — 5 
15 — 30 

2 — 5 

10 — 30 
8 — 20 

3 — 15 
60 — 240 

5 — 10 

1 — 3 

15 — 30 

10 — 30 

60 
% — 1 



715 



% 



4 — 6 
60 — 240 
30 — 120 

5 — 10 
1 — 3 
5 — 20 
3 — 10 
5 — 15 

1 — 10 

2 — 8 
5 — 20 
2 — 10 
2 — 8 
5 — 10 
5 — 15 
8 — 20 

72 — 1 
10 — 20 
2 — 10 

1 — 3 

2 — 4 

3 — 10 
3 — 10 
5 — 15 
5 — 20 

10 — 15 

Vie — % 

1 — 3 

% — 1 
3 — 15 
1 — 5 

72 — 2 
1 — 5 
1 — 3 
5 — 15 



0.015 

0.3 

0.0003 

0.008 

0.0005 

0.2 

1. 

0.13 

1. 

0.5 

0.2 

4. 

0.3 

0.06 

1. 

0.6 

4. 

0.015 

0.004 

0.25 

4. 

2. 

0.3 

0.06 

0.3 

0.2 

0.3 

0.06 

0.12 

0.3 

0.13 

0.13 

0.3 

0.3 

0.5 

0.03 

0.6 

0.13 

0.06 

0.13 

0.2 

0.2 

0.3 

0.3 

0.6 

0.004 

0.06 

0.02 

0.2 

0.06 

0.03 

0.06 

0.06 

0.3 



0.03 

1. 

0.0006 

0.015 

0.002 

0.3 

2. 

0.3 

2. 

1.3 

1. 

15. 

0.6 
0.2 
2. 
2. 

0.06 
0.012 
0.4 
15. 
8. 
0.6 

■ 0.2 
1.3 

• 0.6 

• 1. 

■ 0.6 

■ 0.5 

■ 1.3 

• 0.6 

• 0.5 

- 0.6 

■ 1. 

■ 1.3 

- 0.06 

■ 1.3 

- 0.6 

- 0.2 

- 0.25 

- 0.6 

- 0.6 

- 1. 

- 1.3 

- 1. 

- 0.008 

- 0.2 

- 0.06 

- 1. 

- 0.3 

- 0.13 

- 0.3 

- 0.2 

- 1. 



* In the insane %% grain (0.002 Gm.) cautiously increased until effect is produced. 



560 



APPENDIX. 



Remedy 



Iron, carbonate, sacch 

caseinate 

chlorid, ferrous 

dialysed, liq 

scales 

ferrocyanid 

glycerinophosphate 

hydrocyanate 

hypophosphite 

iodid 

sacch 

lactate 

oxalate 

oxid, black 

brown 

saccharated 

peptonized 

phosphate, precip 

solution 

picrate 

pyrophosphate 

reduced 

salicylate 

subsulphate 

succinate 

sulphate 

dried 

tartrate 

valerianate 

and ammon. citr. .* 

sulphate, ferric 

and magnesium sulphate 

and manganate lactate 

and manganate peptonized, dry, 

and manganate sulphate 

and potassium tartrate 

and quin. arsenate 

citr 

citrate, with strychnine 

hypophosphate 

valer 

and sod. oxal 

and strychnin citrate 



Isopral 

Isson . . 



Jaborandi 

Jalap 

Juglandin 

Juice, belladonna, 
celandine 



Grains or minims' 



Grams or Cc. 



cineraria, in eye 

conium 

digitalis 

hyoscyamus 



10 — 30 
3 — 10 
2 — 4 

10 — 30 

y a — 2 

2 — 5 

2 — 5 
% — 1 

5 — 10 
Va — 3 

2 — 5 

1 — 5 

2 — 6 
2 — 4 

60 — 240 
10 — 30 
5 — 20 
5 — 10 
5 — 10 
H — 1 
5 — 10 

2 — 5 

3 — 10 

2 — 5 
10 — 60 

1 — 3 

y 2 -2 

5 — 10 

3 — 15 
3 — 10 
5 — 15 
5 — 10 

2 — 5 
5 — 20 

1 — 2 
5 — 10 

%* — % 

3 — 10 

4 — 10 
3 — 10 

2 — 10 

3 — 15 
2 — 5 

7 — 22 
30 — 60 

10 — 30 
10 — 30 

2 — 5 

3 — 10 
10 — 20 

2 — 3 
20 — 60 

3 — 10 
30 — 60 



0.6 

0.2 

0.13 

0.6 

0.03 

0.13 

0.13 

0.03 

0.3 

0.03 

0.13 

0.06 

0.13 

0.13 

4. 

0.6 

0.3 

0.3 

0.3 

0.015 

0.3 

0.13 

0.2 

0.13 

0.6 

0.06 

0.03 

0.3 

0.2 

0.2 

0.3 

0.3 

0.13 

0.3 

0.06 

0.3 

0.004 

0.2 

0.25 

0.2 

0.13 

0.2 

0.13 

0.5 
2. 

0.6 

0.6 

0.13 

0.2 

0.6 

0.13 

1.3 

0.2 

2. 



2. 
0.6 
0.25 
2. 

0.13 
0.3 
0.3 
0.06 
0.6 
0.2 
0.3 
0.3 
0.4 
0.25 
15. 
2. 

1.25 
0.6 
0.6 
0.06 
0.6 
0.3 
0.6 
0.3 
4. 
0.2 
0.13 
0.6 
1. 

0.6 
1. 
0.6 
0.3 
1.25 
0.13 
0.6 
0.008 
0.6 
0.6 
0.6 
0.6 
1. 
0.3 

1.5 

4. 

2. 
2. 

0.3 

0.6 

1.3 

0.2 

4. 

0.6 

4. 



DOSE TABLE. 



561 



Remedy 



Juice, pawpaw, dry 

sambucus 

scoparius 

taraxacum 

Kairin 

Kalagua 

Kamala 

Kermes mineral, emetic 

Kino 

Kolanin 

Kosin 

Koussein, amorph 

Krameria 

Kreosolid 

Kryofin 

Labarraque's solution. . . 

Lactucin 

Lactopeptin 

Lactophenin 

Lactucarium 

French 

Lantanin 

Largin 

Lead, acetate 

iodid 

nitrate 

Lecithin 

Leontodin 

Leptandra 

Leptandrin 

Levulose (daily) c 

Levurinose 

Lienaden 

Lime, sulphurated 

Lipanin.. 

Lithium, acetate 

arsenate 

benzoate 

bitartrate 

borocitrate 

bromid 

carbonate 

citrate 

dithiosalicyl 

formate 

glycerinophosphate . 

hippurate 

iodid 

phosphate 

salicylate 

sulphate (daily) 

urate (daily) 

valerian 

vanadate (daily) 



Grains or minims 



5 — 10 
60 — 240 
60 — 120 
60 — 240 

2 — 8 

3 — 8 
60 — 120 

5 — 20 
10 — 20 

3 — 5 
20 — 30 
15 — 30 
15 — 60 

5 — 10 

8 — 15 



20 
1 

10 
8 
2 
3 

15 
5 
1 
1 
1 
3 
2 

20 
1 

60 
120 

y 4 

60 



Veo 
5 

1 

5 

5 

5 

3 

1 

2 

5 

1 

10 

10 

10 

5 

5 

30 



— 60 

— 5 

— 20 

— 15 

— 220 

— 30 

— 30 

— 8 

— 4 

— 4 

— 4 

— 8 

— 4 

— 60 

— 8 
375 

— 240 

— 240 

— 2 

— 240 

— 24 

— Vie 

— 20 
5 

— 5 

— 20 

— 15 

— 15 

— 10 

— 3 

— 5 

— 20 

— 5 

— 30 

— 30 

— 30 

— 30 

— 15 

— 60 




562 



APPENDIX. 



Remedy- 



Grains or minims i 



Grams 01 Cc. 



Lithium and potassium tartrate 

and sod. benz 

and sod. salicyl 

Lobelin sulphate 

Loretin-bismuth 

Lugol's solution 

Lupulin 

Lycetol 

Lycopin 

Lysol 

Macrotin 

Magnesium, benzoate 

biphosphate 

bisulphate 

borate 

borocitr 

bromid 

cacodylate 

carbonate 

chlorid 

citrate 

copaivate 

ergotinate 

glycerino-phosphate 

gynocardate 

hydrate, moist 

hypophosphate 

hyposulphate 

iodid 

lactate 

lactophosphate 

malate 

oxid 

peptonized 

phosphite 

salicylate 

silicate 

sulphate 

sulphite 

sulphophenolate 

valerianate 

Malakin 

Malarin 

Mallein, horse 

Manganese, arsenate 

bromid 

carbonate 

chlorid 

citrate 

dioxi d 

hypophosphite 

iodid 

lactate 

lactophosphate 

oxid 



Vie 

10 — 30 
10 — 30 
Vc-1 
5 — 10 

2 — 10 
10 — 20 

4 — 10 

1 — 4 
30 — 120 

Va-2 

5 — 20 
10 — 30 

5 — 20 
5 — 20 

15 — 30 

10 — 20 

V2— 1 

30 — 120 
240 — 480 

30 — 120 

10 — 20 

%— 1 

3 — 10 
15 — 60 
60 — 120 
10 — 20 
10 — 30 

2 — 10 
15 — 45 

3 — 15 
30 — 120 
10 — 60 

1 — 2 
5 — 20 

15 — 60 
60 — 240 
240 — 480 
10 — 60 
15 — 30 

3 — 10 
10 — 20 

8 — 15 
% — 1 
Mm — % 

2 — 8 
10 — 40 

3 — 12 

1 — 3 

2 — 10 
10 — 20 

1 — 3 
1—5 

1 — 5 

2 — 10 



0.004 

0.6 

0.6 

0.01 

0.3 

0.13 

0.6 

0.25 

0.06 

2. 

0.03 

0.3 

0.6 

0.3 

0.3 

1. 

0.6 

0.03 

2. 
15. 

2. 

0.6 

0.04 

0.2 

1. 

4. 

0.6 

0.6 

0.13 

1. 

0.2 

2. 

0.6 

0.06 

0.3 

1. 

4. 
15. 



6 — 



.2 

.6 

.5 
0.04 
0.0C2 
0.13 
0.6 
0.2 
0.06 
0.13 
0.6 
0.06 
0.06 
0.06 
0.12 



2. 

2. 

0.06 

0.6 

0.6 

1.3 

0.6 

0.25 

8. 

0.13 

1.3 

2. 

1.3 

1.3 

2. 

1.3 

0.06 

8. 

30. 
8. 
1.3 
0.06 
0.6 
4. 
8. 
1.3 
2. 
0.6 
3. 
1. 
8. 
4. 

0.12 
1.3 
4. 

15. 

30. 
4. 
2. 
0.6 
13. 
1. 

0.06 
0.12 
0.5 
2.5 
0.75 
0.2 
0.6 
1.3 
0.2 
0.3 
0.3 
0.6 



DOSE TABLE. 



563 



Remedy- 



Manganese, peptonized 

phosphate 

salicylate 

sulphate 

sulphite 

sulphophenolate. . . 

and iron lactate . . . 

Mangasol 

Manna 

Mannit 

Maretin 

Mass, blue 

copaiba 

ferrous carbon 

Matico 

Meconarcein 

Medulladen 

Melonemetin 

Menispermin 

Menispermum 

Menthol 

Mercurol 

Mercury, albumin., liq. 

amido-prepionate . . 

asparaginate 

benzoate, mercuric 

bichlorid 

biniodid 

bisulphate 

bromid, mercuric . . 

bromid, mercurous. 

cacodylate 

carbolate 

chlorid, mild 

^cathartic) 

cyanid 

gallate 

glycocolate 

iodid, proto 

naphtolate 

nitrate, mercuric . . 



Grains or minims 



Grams or Cc. 



mercurous 

oxid, black 

phosphate (mercuric and mercurous) 

salicylate 

sozoiodolate 

subsulphate 

(alterative) 

succinimid 

sulphid, black 

red 

tannate 

thymol-acetate . . . .' 

tribromphenol-acetate 

and antimony sulphid 

and arsen. iod 



10 
1 
3 
5 
5 
3 
1 

10 
240 

60 
3 
3 

10 
3 

30 

Ye 

30 
1 
1 

10 

3 

1 

8 

M2 

Yl2 
Y%2 

Yz* 
Me 

i. 



1G 
1 

M 



— 30 

— 5 

— 10 

— 15 

— 20 

— 15 

— 5 

— 30 

— 180 

— 480 

— 8 

— 15 

— 30 

— 6 

— 60 
_ % 

— 45 

— 1 17 2 

— 5 

— 30 

— 5 

— 5 

— 15 

— y 6 

— Ye 

-Is 

— Vl2 
-% 

1 , 



Y3 



1, 
1 

15 



5 

Me 

1 

Ye 

i.. 
).> 

h-,4 — Ys 

1 b — 1 i 
M 

Ye 

i .. 



-3 

2 

1 



1 1 — i -. 



1 1 

i . 

3 
15 
1 
1 
5 
2 
Ye± 



15 
30 
2 
2 

4 

Y*2 



0.6 
0.06 
0.2 
0.3 
0.3 
0.2 
0.06 
0.6 
15. 
4. 
0.2 
0.2 
0.6 
0.2 
2. 

0.01 
2. 

0.06 
0.06 
0.6 
0.2 
0.06 
0.5 
0.005 
0.005 
0.002 
0.002 
0.004 
0.02 
0.004 

0.03 

0.015 

0.02 

0.3 

0.004 

0.06 

0.01 

0.03 

0.03 

0.001 

0.002 

0.015 

0.01 

0.02 

0.06 

0.13 

0.015 

0.012 

0.2 

1. 

0.06 

0.06 

0.13 
0.001 



2. 

0.3 

0.6 

1. 

1.3 

1. 

0.3 

2. 
30. 
30. 

0.5 

1. 

2. 

0.4 

4. 

0.03 

3. 

0.1 

0.3 

2. 

0.3 

0.3 

1. 

0.01 

■ 0.01 

■ 0.008 
0.015 
0.005 

0.015 
0.006 

• 0.03 

■ 0.06 

■ 1. 

■ 0.008 

■ 0.2 

0.13 

• 0.06 
0.008 

• 0.015 
0.2 
0.06 

- 0.06 

- 0.2 

- 0.3 

- 0.03 

■ 0.025 

■ 1. 

■ 2. 

■ 0.13 

- 0.13 

• 0.3 

- 0.25 

• 0.002 



564 



APPENDIX. 



Remedy- 



Mercury and potassium hyposulphate 

with chalk 

Mesotan 

Metacresoi 

Metaldehyd 

Methacetin 

Methyl, salicylate 

Methylal 

Methylen blue 

Mezereum 

Migrainin 

Migrol 

Mirmol 

Mixture, acid sulphuric 

ammon. chlor 

almond, B. P 

camphor, acid 

chalk 

carminative 

chloral and potassium bromide . . . 

chloroform 

and cannab. ind. co 

copaiba co 

creosote, B. P 

diarrhoea, N. F 

guaiac 

glycyrrhiza co 

iron, arom. , B. P 

comp 

and ammon. acet 

licorice comp 

magnes and asaf et 

oil tar . 

oleobalsamic * 

potass, citr 

rhubarb co 

rhubarb and soda 

sassafras and opium 

scammony, B. P 

soda and peppermint 

Monesin 

Monobromacetanilid 

Morphin 

Mucin 

Muscarin, nitrate 

Musk 

Myricin 

Myrrh 

Myrtol 

Naphtalin 

Naphtol (beta) 

Narcein 

Narcotin 

Narcyl (daily) 

Neurodin 



Grains or minims 



Grams or Cc. 



XL 



1. 



V3 



3 — 10 
60 

1 — 3 

2 — 8 

4 — 8 

5 — 10 
8 — 60 
2 — 4 
5 — 10 

15 

5 — 10 

480 -» 600 

5 — 20 

60 — 240 

60 — 120 

60 — 240 

120 — 480 

60 — 240 

30 — 60 

60 — 240 

5 — 20 

60 — 240 

240 — 960 

15 — 60 

240 — 960 

120 — 240 

480 — 960 

480 — 960 

120 — 480 

120 — 360 

10 — 30 

30 — 120 

10 — 30 

120 — 480 

60 — 120 

240 — 960 

60 — 120 

480 — 960 

120 — 480 



1C 



u 



no — "V2 
2 — 8 
%— % 
10 



u 



L H2 



1, 



'10 



3 — 10 
1 — 3 
5 — 20 
5 — 15 



2 

3 

u 



15 

8 

1 

10 



L 3 

3 
1 
5 — 25 



0.012 

0.2 

4. 

0.06 

0.13 

0.25 

0.3 

0.5 

0.13 

0.3 

1. 

0.3 
30. 

0.3 

4. 

4. 

4. 

8. 

4. 

2. 

4. 

0.3 

4. 
15. 

1. 
15. 

8. 
30. 
30. 

8. 

8. 

0.6 

2. 

0.6 

8. 

4. 

15. 

4. 
30. 

8. 

0.006 

0.13 

0.008 

0.6 

0.002 

0.2 

0.06 

0.3 

0.3 

0.13 

0.2 

0.02 

0.2 

0.06 

0.3 



0.01 
0.06 

0.2 

0.5 

0.5 

0.6 

4. 

0.25 

0.06 

0.6 
40. 

1.3 
15. 

8. 
15. 
30. 
15. 

4. 
15. 

1.3 
•15. 
60. 

4. 
60. 
15. 
60. 
60. 
30. 
24. 

2. 

8. 

2. 
3i. 

8. 
60. 

8. 
60. 
30. 

0.03 

0.5 

0.03 

0.004 

0.6 

0.2 

1.3 

1. 

1. 

0.5 
0.06 
0.6 

1.6 



DOSE TABLE. 



565 



Remedy 



Grains or minims 



Grams or Cc. 



Neuronal 

Nickel bromid , 

Nickel sulphate. 

Nicotin 

Nitroglucose 

Nuclein (5 percent) 

Nutmeg 

Nutrose 

Nux vomica 



Oculin 

Oil, amber, rectif 

almond, expressed 
animal 



anise 

balm 

basil 

birch bark 

bitter almond 

cajuput 

camphor 

Canada snakeroot 
canella 



caraway 

cardamon 

castor 

celery 

chamomile, German 

chaulmoogra 

chenopodium 

cherry-laurel 

cinnamon 

cloves 

cod-liver 

cochlearia 

cocoanut 

copaiba 

coriander 

croton 

cubebs 



cumm 
dill . . . 



engeron 

eucalyptus 

fennel 

fir, Scotch 

fireweed 

garlic 

gaultheria 

ginger 

hedeoma 

hops 

horsemint 

hyoscyamus 

hyssop 

jatropha curcas. 



y 2 — 

Vu — 
Vso ■ 
10 
5 

15 
1 



15 
10 

1 
Y20 

y 2 o 

60 
20 
30 
5 



0.5 

0.3 

0.03 

0.001 

0.0008 

0.6 

0.3 

1. 

0.06 



1. 

0.6 

0.06 

0.003 

0.003 

4. 

1.3 

2. 

0.3 



5- 


45 
-15 


0.3 


3. 
— 1. 


120- 


-480 


8. 


— 30. 


5- 


-20 


0.3 


— 1.3 


5- 


-10 


0.3 


— 0.6 


1- 


-2 


0.06 


— 0.13 


1- 


-2 


0.06 


— 0.13 


5- 


-30 


0.3 


— 2. 


^g- 


-V2 


0.01 


— 0.03 


5- 


-20 


0.3 


— 1.3 


2- 


-4 


0.13 


— 0.25 


1- 


-2 


0.06 


— 0.13 


1- 


-2 


0.06 


— 0.13 


1- 


-10 


0.06 


— 0.6 


1- 


-2 


0.06 


— 0.13 


240- 


-480 


15. 


— 30. 


1- 


-2 


0.06 


— 0.13 


1 


5 


0.06 


— 0.3 


4- 


-20 


0.25 


— 1.3 


10 




0.6 




y 6 - 


- ¥2 


0.01 


— 0.03 


i- 


-3 


0.06 


— 0.2 


1- 


-5 


0.06 


— 0.3 


60- 


-240 


4. 


-15. 


2- 


-5 


0.13 


— 0.3 


120- 


-240 


8. 


— 15. 


5- 


-15 


0.3 


— 1. 


2 


-5 


0.13 


— 0.3 


1- 


-2 


0.06 


— 0.13 


5- 


-15 


0.3 


— 1. 


1- 


-3 


0.06 


— 0.2 


3- 


-10 


0.2 


— 0.6 


10- 


-30 


0.6 


— 2. 


5- 


-15 


0.3 


— 1. 


5- 


-15 


0.3 


— 1. 


5- 


-10 


0.3 


— 0.6 


2- 


-6 


0.13 


— 0.4 


2- 


-6 


0.13 


— 0.4 


5- 


-20 


0.3 


— 1.3 


1- 


-3 


0.06 


— 0.2 


3- 


-10 


0.2 


— 0.6 


1- 


-5 


0.06 


— 0.3 


2- 


-10 


0.13 


— 0.6 


1- 


-5 


0.06 


— 0.3 


1- 


-5 


0.06 


— 0.3 


2- 


-8 


0.13 


— 0.5 



566 



APPENDIX. 



Remedy 



Grains or minims 



Grams or Cc. 



Oil, juniper 5 

laurel ! fi 

lavender 1 

male fern 10 

marjoram, wild 2 

matico ' fa 

mustard ! s 

myrtle Vi 

niaouli 4 

nutmeg 1 

expressed 2 

olive 120 

pennyroyal 3 

pepper 1 

peppermint 1 

phosphorated 1 

pimento 2 

pinus pumilio 5 

rosemary 2 

rue 10 

santal 5 

sassafras 1 

savin 1 

sesam 240 

spearmint 2 

tansy 1 ■ 

tar 2 

thyme 3 

turpentine 5 ■ 

valerian 3 

wintergreen 5 - 

wormseed, levant 1 - 

wormwood 1 - 

yarrow 1 - 

Oleocreosote 10 - 

Oleoguaiacol 5 - 

Oleoresin, aspidium 120 - 

capsicum M - 

cubebs 10 - 

ginger 2 L» - 

lupulin 2 - 

male fern 120 - 

matico 3 - 

mezereon 3 •> - 

pepper 1 i - 

Olibanum 10 - 

Opium, powdered 1 ->- 

Orexin 4 - 

tannate 4 - 

Orphol 5 - 

Orthin hydroch 3 - 

Orthof orm 5 - 

New 8- 

Ossagen 30 - 

Ovaraden : 15 - 

Ovariin . . 3 - 



-15 


0.3 


— 1. 


-3 


0.03 


— 0.2 


-5 


0.06 


— 0.3 


-30 


0.6 


— 2. 


-10 


0.13 


— 0.6 


-1 


0.03 


— 0.06 


-'. 


0.008 


— 0.015 


-4 


0.03 


— 0.25 


-15 


0.25 


— 1. 


5 


0.06 


— 0.3 


-5 


0.13 


— 0.3 


-480 


8. 


— 30. 


-10 


0.2 


— 0.6 


-3 


0.06 


— 0.2 


-5 


0.06 


— 0.3 


-5 


0.06 


— 0.3 


5 


0.13 


— 0.3 


-10 


0.3 


— 0.6 


5 


0.13 


— 0.3 


-20 


0.6 


— 1.3 


-20 


0.3 


— 1.3 


3 


0.06 


— 0.2 


5 


0.06 


— 0.3 


-480 


15. 


— 30. 


5 


0.13 


— 0.3 


•5 


0.06 


— 0.3 


5 


0.13 


— 0.3 


10 


0.2 


— 0.6 


30 


0.3 


— 2. 


5 


0.2 


— 0.3 


20 


0.3 


— 1.3 


2 


0.06 


— 0.13 


2 


0.06 • 


— 0.13 


5 


0.06 


— 0.3 


40 


0.6 


— 2.5 


20 


0.3 


— 1.3 


240 


8. 


— 15. 


1 


0.015 


— 0.06 


30 


0.6 


— 2. 


2 


0.03 


— 0.13 


5 


0.13 


— 0.3 


240 


8. 


— 15. 


15 


0.2 


— 1. 


1 


0.03 


— 0.06 


1 


0.015 


— 0.06 


30 


0.6 


— 2. 


2 


0.03 


— 0.13 


10 


0.25 


— 0.6 


8 


0.25 


— 0.5 


15 


0.3 


— 1. 


7 


0.2 


— 0.45 


15 


0.3 


— 1. 


15 


0.5 


— 1. 


60 


2. 


— 4. 


30 


1. 


— 2. 


6 


0.2 


— 0.4 



DOSE TABLE. 



567 



Remedy 



Grains or minims 



Grams or Cc. 



Oxaphor (daily) . . 

(oxycamphor) 

Oxyspartein 



Palladium, chloric! 

Fancreaden 

Pancreatin-albumin. . . 

Pancreatin 

Pankreon 

Papain 

Papaverin, child 

Paracotoin 

Parachlorsalol 

Paracresalol 

Paraf ormaldehyd 

Paraldehyd 

Pareira 

Parthenicin 

Pelletierin sulphate. . . 
Pelletierin tannate. . . . 
Pellotin hydrochlor . . . 

Pental 

Pepper 

Pepsin 

sacchar 

Pereirin 

Peronin 

Petrolatum, liq 

Phaselin 

Pheduretin 

Phenobromate 

Phenacetin 

Phenalgin 

Phenobromate 

Phenocoll hydrochlor. . 

salicylate 

Phenolphtalein 

Phenosal 

Phenoxycaff ein 

Phesin 

Phloridzin 

Phosphorus 

Phosote 

Phosphotal 

Phthisin 

Physostigmine eserine 

Phytin 

Phytolacca root 

Phytolaccin 

Picro toxin 

Piliganine 

Pilocarpin hydrochlor. 

Pilocarpus 

Pimenta 

Piperazin , 

Piperidin, tartrate .... 



45 

8 

i ., 

!.; 

15 

1 — 
5 — 
2- 

2 — 
V12 — 

4 

5 

5 

8 
30 
30 

1 

5 

8 

% 

180 

3 

5 
40 
10 
Vs 
60 

5 



5 
5 
5 

10 
1 

10 
4 
8 

10 
Moo 

15 
1 
4 
M20 
8 
1 
1 
1 Moo 

v% 

Vs 

10 

10 
5 
5 



60 
15 
Wi 

V'A 

60 

IV2 

15 

8 

5 

Vz 

8 

15 

15 

15 

90 

60 

3 

10 

24 

m 

300 

15 

15 

120 

30 

1 

180 

15 

15 

20 

24 

20 

10 

15 

20 

3 

20 

8 

30 

15 

Y20 

30 

15 

8 

y 30 

5 
3 



Vs 
M 
30 
40 
10 
15 



3. 

0.5 

0.03 

0.01 
1. 

0.06 
0.3 
0.12 
0.13 
0.005 
0.25 
0.3 
0.3 
0.5 
2. 
2. 

0.06 
0.3 
0.5 
0.05 
12. 
0.2 
0.3 
2.5 
0.6 
0.02 
4. 
0.3 
0.5 
0.3 
0.5 

3 

3 

3 

6 

0.06 
0.6 
0.25 
0.5 
0.6 

0.0006 
1. 

0.06 
0.25 
0.0005 
0.5 
0.06 
0.06 
0.0006 
0.01 
0.008 
0.6 
0.6 
0.3 
0.3 



4. 
1. 

0.1 

0.02 

4. 

0.1 

1. 

0.5 

0.3 

0.02 

0.5 

1. 

1. 

1. 

6. 

4. 

0.2 

0.6 

1.5 

0.1 
20. 

1. 

1. 

8. 

2. 

0.06 
12. 

1. 

1. 



1. 

1. 
1. 
0. 
1. 
1. 
0. 

1. 

0. 

2. 

1. 

0.003 

2. 

1. 

0.5 

0.002 

0.3 

0.2 

0.002 

0.02 

0.015 

2. 

2.5 

0.6 

1. 



568 



APPENDIX, 



Remedy 



Grains or minims 



Piperin 

Pipitzahoac 

Podophyllin 

(acute constip. ) 

Podophyllotoxin 

Poliganin ; 

Pomegranate 

Populin . '. 

Potassa 

sulphurated 

Potassium, acetate 

antimonate 

arsenate 

arsenite 

benzoate 

bicarbonate 

bichromate 

binoxalate 

bisulphate 

bitartrate 

bromid 

camphorate 

cantharidate 

carbolate 

carbonate 

chlorate 

chlorid 

citrate 

chromate 

cyanid 

f errocyanid 

glycerinophosphate, 75 percent 

hydrate 

hypophosphite 

iodid 

nitrate 

nitrite 

osmate 

permanganate 

perchlorate 

phosphate 

salicylate 

salicylite 

succinate 

sulphate 

sulphite 

sulphocyan 

tartrate 

(laxative) 

tellurate 

valerianate 

and sod. tartrate 

Powder, antimonial 

glycyrrhiz. co 

jalap co 

"James" 



u 



45 

Vs 

Va 

60 
2 

v* 

2 

10 

8 

V20 

V32 

5 

20 

V10 

Vs 

60 

60 

15 

10 

1 
10 
10 

5 

10 

Ve 

%e- 

10 

4 

10 

3 

10 

M 

Vie- 

1 

5 

10 
5 
5 
5 
20 
15 
1 

15- 
60- 

V4- 

2 
120- 

2 
60- 
20- 

2- 



1 
75 



Grams or Cc. 



1 



— IV, 



120 

4 

1 

10 

60 

24 

Mo 

Vic 

20 

60 

% 

IV2 
-120 
-480 
-60 
-30 
- %oo 

5 

-30 
-20 
-20 
-40 

■y 2 

•Vs 
15 
10 
1 

30 
30 
60 
2 
% 
2 
15 
30 
20 
15 
10 
120 
160 
3 
30 
150 
% 
5 

480 
10 
120 
60 
10 



0.03 

3. 

0.008 

0.05 

0.005 

0.01 

4. 

0.13 

0.015 

0.13 

0.6 

0.5 

0.003 

0.002 

0.3 

1.3 

0.004 

0.008 

4. 

4. 

1. 

0.6 

0.0001 

0.06 

0.5 

0.6 

0.3 

0.6 

0.01 

0.004 

0.6 

0.25 

0.015 

0.6 

0.2 

0.6 

0.015 

0.004 

0.06 

0.3 

0.6 

0.3 

0.3 

0.3 

1.3 

1. 

0.06 

1. 

4. 

0.015 

0.13 

8. 

0.13 

4. 

1.3 

0.13 



0.06 

5. 

0.03 

0.1 

0.01 

0.02 

8. 

0.25 

0.06 

0.6 

4. 

1.5 

0.006 

0.004 

1.3 

4. 

0.015 

0.1 

8. 
30. 

4. 

2. 

0.0002 

0.3 

2. 

1.3 

1.3 

2.5 

0.03 

0.008 

1. 

0.6 

0.06 

2. 

2. 

4. 

0.13 

0.015 

0.13 

1. 

2. 

1.3 

1. 

0.6 

8. 

4. 

0. 

2. 
10. 

0.05 

0.3 
15. 

0.6 

8. 

4. 

0.6 



— 0.2 



DOSE TABLE. 



569 



Remedy 



Powder, morph . co 

rhubarb co 

Prasoid 

Prostaden 

Protan 

Frotonuclein 

Protylin 

Ptelein 

Ptyalin 

pepsin 

Pumpkin seed 

Pyoktanin 

Pyramidon 

Pyramidon, camphorate, neutral 

salicylate , 

Pyrantin 

Pyranum , 

Pyridin , 

Pyrodin 

Pyrosal 



Quassia 

Quassin, pure 

French 

Quebrachin 

Quillaja 

Quinacetin sulph 

Quinalgen 

Quinaphtol 

Quinetum 

Quinidin 

Quinin and salts 

albuminate 

antimonate 

arsenate 

arsenite 

biniodid (subcut. ) 

dihydrobromate 

ferroarsenate 

ferroarsenite 

ferrocyanid 

f erroiodid 

ferrolactate 

glycerinophos 

peptonate 

salicylate 

sulphocarbol 

tannate, child 

valerian 

and antipyrin salicylate 

and urea hydrochlor. , subcut. 

Quinoidin 

Quinolin, salicylate 

and antipyrin valerianate 

sulph 

tartrate 



Grains or minims 



Grams or Cc. 



5 — 20 


1 0.3 


— 1.3 


30 — 120 


2. 


— 8. 


15 — 30 


! 1, 


— 2. 


5 — 15 


i 0.3 


— 1. 


20 — 30 


1.3 


— 2. 


3 — 10 


1 0.2 


— 0.6 


15 — 60 


1. 


— 4. 


1 — 3 


0.06 


— 0.2 


1C — 30 


0.6 


— 2. 


10 — 30 


0.6 


— 2. 


60 — 120 


4. 


— 8. 


1 — 5 


0.06 


— 0.3 


3 — 8 


0.2 


— 0.5 


12 — 15 


0.75 


— 1. 


8 — 12 


0.5 


— 0.75 


5 — 15 


0.3 


— 1. 


15 — 30 


1. 


— 2. 


2 — 10 


0.13 


— 0.6 


% — 1 


0.015 


— 0.06 


8 — 15 


0.5 


— 1. 


10 — 30 


0.6 


— 2. 


Yso — Ys 


0.002 


— 0.02 


Y2 — 2 


0.03 


— 0.13 


1 — 2 


0.06 


— 0.13 


10 — 30 


0.6 


— 2. 


5 — 15 


0.3 


— 1. 


5 — 15 


0.3 


— 1. 


8 — 15 


0.5 


— 1. 


1 — 8 


0.06 


— 0.5 


% — 3 


0.03 


— 0.2 


2 — 15 


0.13 


— 1. 


2 — 15 


0.13 


— 1. 


IY2 — 6 


0.1 


— 0.4 


Vie— y 8 


0.004 


— 0.008 


Yls — Ys 


0.004 


— 0.008 


IY2 


0.1 




3 — 20 


0.2 


— 0.3 


Vio — Ys 


0.004 


— 0.008 


Yw — Ys 


0.004 


— 0.008 


5 — 10 


0.3 


— 0.6 


8 — 15 


0.5 


— 1. 


8 — 15 


0.5 


— 1. 


2 — 5 


0.13 


— 0.3 


5 — 60 


0.3 


— 4. 


2 — 30 


0.13 


— 2. 


2 — 8 


0.13 


— 0.5 


5 — 15 


0.3 


— 1. 


2 — 6 


0.13 


— 0.4 


2 — 8 


0.12 


— 0.5 


2 — 8 


0.13 


— 0.5 


2 — 15 


0.13 


— 1. 


8 — 15 


0.5 


— 1. 


2 — 8 


0.12 


— 0.5 


5 — 20 


0.3 


— 1.3 


5 — 20 


0.3 


— 1.3 



570 



APPENDIX. 



Remedy 



Quinoral 

Quinopyrin 

Renaden 

Resin, copaiba 

jalap 

podophyllum 

quebracho 

scammony 

sumbul 

veratrum 

Resopyrin 

Resorcin 

Rhamnin 

Rhubarb 

Rhusin 

Rubidium bromid 

iodid 

and ammon bromid 
Rumin 

Saccharin 

Saffron 

Safrol 

Salacetol 

Salfene 

Salibromin 

Salicin 

Salicylamid 

Salicyl-resorcin 

Saliformin 

Saligenin 

Salipyrin 

Salocoll 

Salol 

Salophen 

Saloquinin, 

Salicylate 

Sanguinaria 

Sanguinarin 

Sanguinoform 

Santonin 

Santoninoxim 

Sarcosin 

Scammony 

Scillipicrin 

Scillitin 

Scillitoxin 

Scoparin 

Scopolamin hydrobrom. . . 

Scutellarin 

Senecin 

Senegin 

Senna 

Serpentaria 

Serum, antistreptococcic. 



Grains or minims 



8- 
8 

30 

5 

1 
%■ 

1 

3 

1 

y« 

5 
2 
2 
3 
1 
5 
1 
20 
1 



20 
25 



15 

3 

V* 

2 

8 

8 

Vx 

10 

3 

6 

10 

2 

15 

5 

60 

3 



Grams or Cc. 



0.5 
0.5 

2. 

0.3 

0.06 

0.008 

0.06 

0.2 

0.06 

0.01 

0.3 

0.13 

0.13 

0.2 

0.06 

0.3 

0.06 

1.3 

0.06 



1.3 
1.5 



1. 

0.2 

0.03 

0.12 

0.5 

0.5 

0.015 

0.6 

0.2 

0.4 

0.6 

0.13 

1. 

0.3 

4. 

0.2 



1 — 5 


0.06 


— 0.3 


10 — 20 


0.6 


— 1.3 


30 — 60 


2. 


— 4. 


15 — 45 


1. 


— 3. 


5 — 10 


0.3 


— 0.6 


30 — 75 


2. - 


— 5. 


10 — 30 


0.6 


— 2. 


3 — 5 


0.2 


— 0.3 


5—15 


0.3 


— 1. 


5 — 10 


0.3 


— 0.6 


5 — 15 


0.3 


— 1. 


10 — 30 


0.6 


— 2. 


10 — 20 


0.6 


— 1.3 


5 — 15 


0.3 


— 1. 


10 — 20 


0.6 


— 1.3 


8 — 30 


0.5 


— 2. 


10 — 15 


0.6 


— 1. 


3 — 20 


0.2 


— 1.3 


V12 — Vs 


0.005 


— 0.2 


30 


2. 




2 — 4 


0.13 


— 0.25 


1 — 5 


0.06 


— 0.3 


8 — 15 


0.5 


— 1. 


5 — 15 


0.3 


— 1. 


Vs — 1 


0.02 


— 0.06 


Ve — y 2 


0.01 


— 0.03 


Vqo — %0 


0.001 


— 0.002 


5 — 15 


0.3 


— 1. 


Mjso — Veo 


0.00025— 0.001 


1 — 4 


0.06 


— 0.25 


1 — 3 


0.06 


— 0.2 


Y2 — 2 


0.03 


— 0.13 


60 — 240 


4. 


— 15. 


10 — 30 


0.6 


— 0.2 


150 — 300 


10. 


— 20. 



DOSE TABLE, 



571 



Remedy 



Grains or minims 



Grams or Cc. 



Sidonal , 



new. 



Silin (daily) 

Silver, arsenite 

chlorid 

cyanid. 

iodate 

iodid 

nitrate 

oxid 

Smilacin amorph 

Soap :-. 

Soda (caustic) 

Sodium, acetate 

anisate 

arsenate 

benzoate 

" bicarbonate '. 

bisulphite 

borate 

borobenzoate 

borocitr 

borosalicyl 

borotartrate 

bromid 

cacodylate 

carbolate 

carbonate 

cetrarate 

chlorate 

chlorid 

chloroborate 

choleate 

cinnimate, subcut 

citrate 

citrobenzoate 

copaivate , 

cresotinate 

cyanid 

dithiosalicylate 

ethyl-sulph 

fluorbenzonate 

fluorid 

formate 

glycerino-phosph (75 percent) 

glycocholate (daily) 

gynocardate 

hippurate 

hydrate 

hypophosphite 

hyposulph 

iodid 

lactate 

meta-vanadate 

methylarsenate (daily).. ..... 

naphtolate, ................. ; 



15 — 20 


1. 


— 1.3 


30 — 45 


2. 


— 3. 


45 


3. 




] L2f) — '()0 


0.0005 


— 0.001 


te — iy 2 


0.03 


— 0.01 


1 60 — V2'0 


0.001 


— 0.003 


%2 — Vg 


0.005 


— 0.0 


'.-1 


0.015 


— 0.06 


Vh — V-2 


0.008 


— 0.03 


^2 — Vti 


0.005 


— 0.03 


1 — 3 


0.06 


— 0.2 


3 — 10 


0.2 


— 0.6 


¥2 — 1 


0.03 


— 0.06 


15 — 120 


1. 


— 8. 


5 — 15 


0.3 


— 1. 


Y24. — V8 


0.0025 


— 0.008 


10 — 40 


0.6 


— 2.5 


10 — 40 


0.6 


— 2.5 


10 — 30 


0.6 


— 2. 


20 — 40 


1.3 


— 2.5 


30 — 120 


2. 


— 8. 


15 — 30 


1. 


— 2. 


5 — 15 


0.3 


— 1. 


1 — 2 


15. 


— 30. 


10 — 60 


0.6 


— 4. 


1 — 5 


0.06 


— 0.3 


2 — 10 


0.13 


— 0.6 


5 — 20 


0.3 


— 1.3 


3 — 15 


0.2 


— 1. 


5 — 15 


0.3 


— 1. 


10 — 06 


0.6 


— 4. 


10 — 15 


0.6 


— 1. 


5 — 10 


0.3 


— 0.6 


% — 1 


0.02 


— 0.06 


15 — 60 


1. 


— 4. 


5 — 15 


0.3 


— 1. 


10 — 30 


0.6 


— 2. 


3 — 24 


0.2 


— 1.5 


V20— '% 


0.003 


— 0.015 


2 — 10 


0.13 


— 0.6 


60 — 300 


4. 


— 20. 


5 — 10 


0.3 


— 0.6 


Vx2 — Ve 


0.005 


— 0.01 


V2 — 3 


0.03 


— 0.2 


4 — 10 


0.25 


— 0.6 


60 — 75 


4. 


— 5. 


5 — 15 


0.3 


— 1. 


10 — 20 


0.6 


— 3.1 


lo_l 


0.03 


— 0.06 


10 — 30 


0.6 


— 2. 


5 — 20 


i 0.3 


— 1.3 


5 — 60 


' 0.3 


— 4. 


120 — 480 


8. 


— 15. 


Vm — Vs 


0.001 


— 0.008 


Y2 — IV2 


0.03 


— 0.1 


3 — 10 


0.2 


— 0.6 



572 APPENDIX 


• 






Remedy 


Grains or minims 


Grams or Cc. 


Sodium, nitrate 


10 — 60 

1 — 3 

2 — 5 
2 — 20 
1 — 3 
8 — 30 
5 — 40 
5 — 40 
1 — 5 
5 — 40 
1 — 6 
1 — 6 
5 — 30 

1 — 5 
10 — 15 

120 — 480 

lO-r-60 

10 — 30 

60 — 300 

240 — 480 

2 — 6 
% — 1 

5 — 20 
1 — 5 

V64— Vs 

2 g 

60 — 120 
5 — 15 
120 — 480 
30 — 120 
30 — 60 
20 — 30 
5 — 10 
1 — 4 
60 — 240 
30 — 120 
5 — 10 
15 — 60 
10 — 30 
60 — 120 

1 — 5 
30 — 120 

5 — 15 
60 — 240 
15 — 60 

2 — 10 
2 — 10 
1 — 5 

60 — 240 
5 — 15 
5 — 15 
1 — 5 

30 — 120 
5 — 15 

10 — 30 


0.6 
0.06 
0.12 
0.13 
0.06 
0.5 
0.3 
0.3 
0.06 
0.3 - 
0.06 
0.06 
0.3 
0.06 
0.6 
8. 
0.6 
0.6 
4. 
15. 
0.13 
0.015 
0.3 
0.06 
0.001 
0.015 
0.13 
4. 
0.3 
8. 
2. 
2. 
1.3 
0.3 
0.06 
0.4 
2. 
0.3 
1. 

0.6 
4. 

0.06 
2. 
0.3 
4. 
1. 

0.13 
0.13 
0.06 
4. 
0.3 
0.3 
0.06 
2. 
0.3 
0.6 


— 4. 


nitrite 


— 0.2 


oleate 


— 0.3 


paracresotate 


— 1.3 


persulphate 


— 0.2 


phenolsulphonate 

phosphate 


— 2. 

— 2.5 


pyrophosph 


— 2.5 


saccharinate 


— 0.3 


salicylate 

santonate 


— 2.5 

— 0.4 


santoninate 


— 0.4 


sozoidole 


— 2. 


succinate 


— 0.3 


sulphanilate 


— 1. 


sulphate 


— 30. 


sulphite 


— 4. 


sulphosalicyl 


— 2. 


sulphovinate 

tartrate 

taurochol 

tellurate 


— 20. 

— 30. 

— 0.4 

— 0.06 


thiosulph 


— 1.3 


valerianate 


— 0.3 


vanadate 


— 0.008 


Solanin 

Solution, acid arsenous 

acid phosphoric comp 


— 0.06 

— 0.5 

— 8. 


alumin. acet 


— 1. 


ammon. acet 


— 30. 


concent *. 


— 8. 


citrate, cone 


— 4. 


ammon. succin 


— 2. 


arsen. and mere, iod 


— 0.6 


atropin sulphate 


— 0.25 


bismuth 


— 15. 


bismuth and ammon. ctr 


— 8. 


calc. chlorydrophos 


— 0.6 


chlorid 


— 4. 


ergotin 


— 2. 


ext. licorice 


— ' 8. 


Fowler's 


— 0.3 


erinerer 


— 8. 


gold and arsen. bromides 


— 1. 


hydrogen perox 


— 15. 


hypophosphites 


— 4. 


iodin comp 


— 0.6 


iron acetate 

cone 


— 0.6 

— 0.3 




— 15. 


iron chlor. ferrous 

iron citr 


— 1. 

— 1. 


iron iodid 


— 0.3 


iron malate 


— 8. 


iron nitr 


— 1. 




— 2. 



DOSE TABLE. 



573 



Remedy 



Grains or minims 



Grams or Cc. 



Solution, iron protochlor 

iron subsulph 

iron and ammon. acet 

iron and ammon. citr 

iron and mangan. pept 

lime, chlorin 

sacchar 

magnes. carbon 

magnesium bromid 

glycochol 

mercury and potass, iodid. . 

morphin acet._ 

citrate 

sulph 

nitroglycer 

pancreatic , 

pepsin , 

arom 

phosphorus 

potassa 

potass, arsenate and brom 
arsenite 

saccharin 

soda, chlorin 

sodium arsenate 

hydrate 

Somnal 

Somnalgesin 

Somnoform 

Spartein sulph •• . . 

Spasmotin 

Sphacelotoxin 

Spigelia 

Spinol 

Spirit, ammonia, arom 

anise 

aromatic 

chloroform 

cinnamon 

ether 

comp 

gaultheria 

glonoin 

juniper 

comp 

melissa. cone 

nitroglycer. (spt. glonoin) 

nitrous ether 

nutmeg 

phosphorus 

spearmint 

witch-hazel 

Squill 

Starch, iodized 

Steresol 

Stillingin 



1- 
2- 

240- 

• 5- 

30- 

20- 

15- 

480- 

60- 

8- 

2- 

15- 

4- 

15- 

1- 

60- 

30- 

60- 

20- 

5- 

1- 

1- 

5- 

20- 

3- 

5- 

15- 

1- 

5- 

M- 

v-2- 

V>2- 

60- 
1- 
60 
30- 
30- 
30- 
10 
30 
?&■ 
30 
1 
60 
240 
30 
1 
30 
30 
10 
15 
3 
1 
3 

Vi- 
2 



5 

10 

480 

20 

60 

60 

60 

960 

120 

15 

5 

60 

15 

60 

3 

■240 
-120 
•240 

60 
■20 
-5 

5 

30 
-60 
-10 
-20 
■30 

5 
-7 

1 

■ m 

-m 

-120 

-8 

-120 

-120 

-120 

-60 

-30 

-60 

-60 

-120 

-3 

-180 

-480 

-60 

-3 

-90 

-120 

-40 

-40 

-15 

-3 

-10 

-1 

-4 



0.06 

0.13 
15. 

0.3 

2. 

1.3 

1. 
30. 

4. 

0.5 

0.13 

1. 

0.25 

1. 

0.06 

4. 

2. 

4. 

1.3 

0.3 

0.06 

0.06 

0.3 

1.3 

0.2 

0.3 

1. 

0.06 

0.3 

0.015 

0.03 

0.03 

4. 

0.06 

4. 

2. 

2. 

2. 

0.6 

2. 

2. 

2. 

0.06 

4. 
15. 

2. 

0.06 

2. 

2. 

0.6 

1. 

0.2 

0.06 

0.2 

0.015 

0.13 



0.3 
0.06 
30. 
1.3 

4. 

4. 

4. 

60. 



— 0.3 



1. 

0. 

4. 

1. 

4. 

0.2 
15. 

8. 
15. 

4. 

1.3 

0.3 

0.3 

2. 

4. 

0.6 

1.3 

2. 

0.3 

0.4 

0.06 

0.1 

0.1 
■ 8. 

0.5 



4. 

2. 

4. 

4. 

8. 

0.2 
12. 
30. 

4. 

2. 

6. 

8. 

2.5 

2.5 

1. 

0.2 

0.6 
■ 0.06 

0.25 



574 



APPENDIX. 



Remedy 



Grains or minims 



G. - ams or Cc. 



Storax 

Stramonium seed 

leaves 

Strontium, acetate 

arsenite 

bromid 

iodid 

lactate 

salicylate 

Strophanthin 

Strychnin 

arsenate. 

arsenite 

cacodylate 

hypophosp 

nitrate 

sulphate 

Stypticin 

Styptol 

Sugar, milk, daily 

Sulfonal 

Sulphaminol, salicylate... 
Sulphur, iodid 

precipit 

washed 

Syrup, acacia 

acid citric 

acid hydriod 

blackberry, arom 

calcium, iodid 

lactophosphate 

with iron 

and sod. hypophosph. 

chondrus, comp 

chloral 



cinnamon 

codein 

eriodictyon, arom 

garlic 

ginger 

glycyrrhiza 

hypophosphites . . 
with iron 



ipecac 

and opium 

iron arsen 

bromid 

citro-iodid 

hypophosph 

iodid 

lactophosphate 

oxid 

phosphate 

protochlor 

quin. and strych. phosph. 

saccharated 



5 — 

1 — 

2 — 

li — 
^o — 
10 — 
10 — 
10 — 
10 — 

%* 

Vaz 

ft* 

% 

1 

1 

15 
3 
1 

30 

60 
120 
120 

30 
120 

60 

60 

60 

60 

60 

30 

60 

60 

60 

60 
120 

60 

60 

60 

20 

60 

60 

10 

15 

60 

15 

60 

60 

30 

30 

60 

60 



20 

3 

5 

1 

Vls 

40 

20 

30 

40 

Vet* 

Ms 

416 

He 

Vs 

% 

2% 

6 oz. 

45 

6 

4 

120 

180 

480 

480 

60 

240 

120 

120 

240 

240 

120 

120 

240 

240 

240 

120 

240 

240 

240 

120 

240 

180 

120 

30 

60 

180 

30 

120 

120 

60 

120 

120 

180 



0.3 
0.06 
0.13 
0.015 
0.002 
0.6 
0.6 
0.6 
0.6 

0.0003 
0.001 
0.001 
0.001 
0.002 
0.002 
0.001 
t 0.001 
i 0.025 
0.06 
30. 
1. 

0.2 
0.06 
2. 
4. 



2. 

8. 

4. 

4. 

4. 

4. 

4. 

2. 

4. 

4. 

4. 

4. 

8. 

4. 

4. 

4. 

1.3 

4. 

4. 

0.6 

1. 

4. 

1. 

4. 

4. 

2. 

2. 

4. 

4. 



1.3 

0.2 

0.3 

0.06 

0.004 

2.5 

1.3 

2. 

2.5 

0.001 

0.004 

0.004 

0.004 

0.02 

0.005 

0.002 

0.002 

0.05 

0.15 
180. 

3. 

0.4 

0.25 

8. 
12. 
30. 
30. 

4. 
15. 

8. 

8. 
15. 
15. 

8. 

8. 
15. 
15. 
15. 

8. 
15. 
15. 
15. 

8. 
15. 
12. 

8. 

2. 

4. 
12. 

2. 

8. 

8. 

4. 

8. 

8. 
12. 



' 



m 

8>- 



DOSE TABLEc 



575 



Remedy 



Grains or minims 



Syrup, iron, arsen., mangan. iodid 

krameria 

lactucarium 

lemon 

lime 



manna 

orange 

flowers 

pectoral 

peppermint 

phosphates, comp... 

poppy 

prun. virg 

raspberry 

rhamnus cath 

rhoeados 

rhubarb 

and potassa, comp 

roses 

rubus 

sanguinaria 

sarsaparilla, co 

senega 

senna 

aromat 

comp 

sodium hypophosph. 
squill 

comp 

stillingia, comp 

tar 

trifolium, comp 

violets 

wild cherry 

white pine, comp . . . 



Taka diastase 

Tannalbin 

Tannigen 

Tannin 

Tannoform 

Tannopin 

Tannosal 

Taphosote 

Tar 

Tartar emetic 

(expectorant) 

(emetic) 

Terebene 

Terpene hydrochlorid 

Terpin hydrate 

Terpinol 

Tetronal 

Testaden 

Thallin, periodid 

tartrate 



Grams or Cc. 



10- 

60- 
30- 
30- 
30- 
60- 

120- 
60- 
60- 
60- 
60- 
60- 
60- 
60- 
60- 
30 
60- 
60- 
30 

120 
15 

120 
30 

120 
60 
60 
60 
30 
15 
60 
60 
60 
60 
60 
60 



30 

240 

120 

60 

60 

240 

480 

180 

120 

180 

120 

120 

240 

240 

250 

60 

480 

240 

60 

■240 

60 

-480 

-120 

-240 

-240 

-240 

240 

60 

-60 

-240 

-240 

-240 

-240 

-240 

-240 



0.6 

4. 

2. 

2. 

2. 

4. 



4. 
4. 
4. 
2. 
1. 
4. 
4. 
4. 
4. 
4. 
4. 



2. 
15. 

8. 

4. 

4. 
15. 
30. 
12. 

8. 
12. 



15. 
15. 
15. 

4. 
30. 
15. 

4. 
15. 

4. 
15. 

8. 
15. 
15. 
15. 
15. 

4. 

4 
15. 
15. 
15. 
15. 
15. 
15. 



1 — 5 


0.06 


— 0.3 


5 — 30 


0.3 


— 2. 


5 — 30 


0.3 


— 2. 


2 — 20 


0.13 


— 13. 


4 — 15 


0.25 


— 1. 


8 — 30 


0.5 


— 2. 


15 — 60 


1. 


— 4. 


15 — 30 


1. 


— 2. 


30 — 60 


2. 


— 4. 


^■2 — Vie, 


0.002 


— 0.004 


V^—Va 


0.0025 


— 0.008 


y 2 


0.03 




4 — 20 


0.25 


— 1.3 


15 — 30 


1. 


— 2. 


3 — 15 


0.2 


— 1. 


2 — 5 


0.13 


— 0.3 


15 — 30 


1. 


— 2. 


30 


2. 




2 — 3 


0.12 


— 0.2 


3 — 8 


0.2 


— 0.5 



w 

n 

■ 






576 



APPENDIX. 



Remedy 


Grains or minims 


Grams or Cc 


Thallin, sulphate 


3 — 8 

3 — 8 
IV2 — 3 

% 

5 — 10 
1 — 3 
5 — 15 
5 — 15 
5 — 15 

15 — 1 

4 — 8 
15 

3 — 8 

5 — 8 
3 — 8 
7 

8 
4 

5 — 20 
5 — 15 
5 — 20 
V2 — IV2 
5 — 15 

1 — 10 

2 — 4 
V2 — 2 

1 — 3 

y 2 — 2 

10 — 30 

3 — 20 
30 — 60 
15 — 60 
30 — 120 
20 — 60 
10 — 60 
10 — 30 
20 — 40 
20 — 60 
10 — 60 
10 — 15 

5 — 20 
20 — 40 
30 — 60 
60 — 240 
30 

10 — 15 
5 — 20 
3 — 10 
15 — 60 
60 — 120 
30 — 120 
60 — 120 
60 — 120 
60 — 120 


0.2 

0.2 

0.1 

0.012 

0.012 

0.3 

0.06 

0.3 

0.3 

0.3 

1. 

0.25 

1. 

0.2 

5.0 

0.2 

0.4 

0.5 

0.25 

0.3 

0.3 

0.3 

0.03 

0.3 

0.06 

0.13 

0.03 

0.005 

0.06 

0.03 

0.6 

0.2 

2. 

1. 

2. 

1.3 

0.6 

0.6 

1.3 

1.3 

0.6 

0.6 

0.3 

1.3 

2. 

4. 

2. 

0.6 

0.3 

0.2 

1. 

4. 

2. 

4. 

4. 

4. 


— 0,5 


tartrate 


— 0.5 


Thallium acetate 


— 0.2 


Thallium, chlorid 

sulphate 

Thanatol = guethol 

Thebain, hydrochlorid 

Theobromin 

and lith. benz 

and lith. salicylate 


— 0.6 

— 0.2 

— 1. 

— 1. 

— 1. 


and sod. benz 




and sod. iodosalicyl 


— 0.5 


and sod. salicyl 

Theocin 


— 0.5 


Theocin-sodium acetate 


— 0.3 


Theophyllin 

sodium 

sodium salicylate 

Thermifugin 


— 0.5 


Thermodin 


— 1.3 


Thermol 


— 1. 


Thiocol 


— 1.3 


Thiosinamin 


— 0.1 


Thymacetin 


— 1. 


Thymol 


— 0.6 


Thyraden 


— 0.25 


Thyroidin (Merck) 

Tin chlorid stannous 


— 0.13 

— 0.03 


Tincture, aconite 


— 0.2 


Fleming: 


— 0.13 


adonis aestiv 


— 2. 


vernalis 


— 1.3 


adulsa vasaca 

aloes 


— 4. 

— 4. 


and myrrh 


— 8. 


antiperiodic 


— 4. 


apocynum 


— 4. 


arnica flow 

root 


— 2. 

— 5. 


asaf etida 

avena sativa 


— 4. 

— 4. 


sat. , co 


— 1. 


belladonna lvs 


— 1.3 


benzoin 

comp 


— 2.5 

— 4. 


bryonia 


— 15. 


bursa pastor 




cactus grandiflor 


— 1. 


cannab. ind 

cantharides 

capsicum 

cardamom 


— 1.3 

— 0.6 

— 4. 

— 8. 


castoreum 


— 8. 


catechu co 


— 8. 


cinchona 


— 8. 




— 8. 



DOSE TABLE. 



577 



Remedy 



.Grains or minims 



Tincture, cinnamon qq 240 

see( \--. :.:.;:::: 20-60 

convallana 5 20 

coronilla 5 j 5 

coto 10 — 20 

gelsemium jq 30 

gentian co ".'.'.' .V .'.' .'.'.' ." 60 — 120 

g ln S er 15 — 60 

guaiac 20 — 60 

amnion 60 — 120 

{;°P S --;: 60-180 

fastis 30-120 

hyoscyamus 20 — 60 

iodin 3 iq 

, comp ::::::::::::::;;: 5-15 

ipecac and opium 5 15 

iron, acet., ether 10 30 

c hj or ---; u :.::: 5-20 

chlor. , ether 10 30 

citro-chlor 10 30 

. Pomated '.'.'.'.'.'.'.'....' 30 — 90 

J ala P 5 — 20 

ku\o.... 60 — 180 

lactucanum q ^q 

lobelia .'.'.'.'.'.'.'.'.'. 10 — 40 

musk , 30-120 

Wrrh 30 — 120 

naregamia y 2 _ 2 

nerium oleander lvs 26 

nutgall '.'.'.'.'.'.'.'.'. 30 — 60 

nux vom 5 20 

opium 5 20 

opium camph gO 240 

paracoto 10 20 

physostigma ......'.'.'.'.'. 5 — 15 

Pulsatilla 5 20 

quassia 60 — 180 

quillaja 20 — 60 

rh ubarb 60 — 240 

aqueous 60 — 240 

arom 30 — 120 

sweet 60 — 240 

and gentian 60 — 240 

toxicodend 5 30 

saffron '.'.'.'.'.'.'.'. 60 — 180 

serpentaria 60 180 

sim . u |o V.V.; 30-60 

squill : 6 — 20 

stramonium g 20 

strophanthus 3 — 10 

sumbul !.';!!;;; 15 — 60 

t0l u-. 30 — 120 

valerian, ammon 60 120 

veratrum, br 5 20 

vir " 3 10 

Warburg's 20 60 



Grams or Cc. 



4. 


— 15. 


1.3 


— 4. 


0.3 


— 1.3 


0.3 


— 1. 


0.6 


— 1.3 


0.6 


— 2. 


4. 


— 8. 


1. 


— 4. 


1.3 


— 4. 


4. 


— 8. 


4. 


— 12. 


2. 


— 8. 


1.3 


— 4. 


0.2 


— 0.6 


0.3 


— 1. 


0.3 


— 1. 


0.6 


— 2. 


0.3 


— 1.3 


0.6 


— 2. 


0.6 


— 2. 


2. 


— 6. 


0.3 


— 3. 


4. 


— 12. 


0.4 


— 2.5 


0.6 


— 2.5 


2. 


— 8. 


2. 


— 8. 


0.03 


— 0.13 




1.3 


2. 


— 4. 


0.3 


— 1.3 


0.3 


— 1.3 


4. 


— 15. 


0.6 


— 1.3 


0.3 


— 1. 


0.3 


— 1.3 


4. 


— 12. 


1.3 


— 4. 


4. 


— 15. 


4. 


— 15. 


2. 


— 8. 


4. 


— 15. 


4. 


— 15. 


0.3 


— 2. 


4. 


— 12. 


4. 


— 12. 


2. • 


• — 4. 


0.4 


— 1.3 


0.4 


— 1.3 


0.2 


— 1.6 


1. 


— 4. 


2. 


— 8. 


4, 


— 8. 


0.3 


— 1.3 


0.2 


— 0.6 


1.3 


— 4. 



578 



APPENDIX. 



Remedy 


Grains or minims 


Grams or Cc. 


Tolypyrin 

Tolysal 

Tribrommethan = bromof orm 

Tribromphenol 


5 — 15 
8 — 30 

2 — 20 

3 — 10 
15 — 30 

5 

5 — 20 
2 — 4 

15 — 30 
8 — 15 

4 — 20 
8 — 24 

i-joo — V120 
2 — 5 
2 — 15 

V20 — Mo 
30 — 45 

1 — 15 
10 — 20 
10 — 45 
15 — 30 
60 — 120 
10 — 15 

8 — 15 
60 — 120 

10 — 30 

8 — 15 
10 — 20 
10 — 15 
10 — 25 

2 — 6 

6 — 30 
Ye — Vs 

Veo — Mjo 
1—2 

5 — 15 
1 — 3 
1 — 4 
5 — 20 

10 — 30 

10 — 30 

4 — 10 
10 — 20 
10 — 20 
15 — 240 
60 — 120 
60 — 240 
20 — 60 

5 — 10 
60 — 180 
60 — 240 

120 — 180 
5 — 20 


0.3 

0.5 

0.13 

0.2 

1. 

0.3 

0.3 

0.13 

1. 

0.5 

0.25 

0.5 

0.0003 

0.13 

0.13 

0.003 

2. 

0.06 

0.6 

0.6 

1. 

4. 

0.6 

0.5 

4. 

0.6 

0.5 

0.6 

0.6 

0.6 

0.12 

0.4 

0.01 

0.001 

0.06 

0.3 

0.06 

0.06 

0.3 

0.6 

0.6 

0.25 

0.6 

0.6 

1. • 

4. 

4. 

1.3 

0.3 

4. 

4. 

8. 

0.3 


— 1. 

— 2. 

— 1.3 

— 0.6 


Tribromsalol 


— 2. 


Triferrin 


• 


Trigemin 


— 1.3 


Trilliin 


— 0.25 


Trional 


— 2. 


Trioxymethylen .' 

Triphenin 

Tuberculin 

Turpentine, chian 

Tussol 

Ulexin 


— 1. 

— 1.3 

— 1.5 

— 0.0005 

— 0.3 

— 1. 

— 0.006 


Uraliam 


— 3. 


Uranium nitrate 


— 1. 


Urea 


— 1.3 


Urethan 

Uricedin 

Urotropin 

Uva ursi 


— 3. 

— 2. 

— 8. 

— 1. 

— 1. 

— 8. 


Valerian 

Valerydin 

Validol 

camphorated 


— 2. 

— 1. 

— 1.3 

— 1. 


Valofin 


— 1.5 


Valyl 


— 0.4 


Vanadin, daily 


— 2. 


Vanillin 


— 0.02 


Veratrin alkaloid 

Veratrol 


— 0.003 

— 0.12 


Veronal 


— 1. 


Viburnin 


— 0.2 


Vieirin 


— 0.25 


Vinegar opium 


— 1.3 


Vinegar squill ... 


— 2. 


Water, ammonia 


— 2. 


cone 


— 0.6 


bitter almond . . 


— 1.3 


cherry laurel 


— 1.3 


chlorin . 


— 15. 


Wine, aloes 


— 8. 


camphorated 


— 15. 


colchicum seed'. 


— 4. 


ipecac 


— 0.6 


emetic 


— 12. 


iron 


— 15. 


bitter 


— 12. 




— 1.3 



MB 



DOSE TABLE. 



579 



Remedy 



Grams or Cc. 



Wine, pepsin . . , 

quinin 

tar 

tobacco 

white ash . . 

wild cherry, 

f errated . . 



Xeroform 

Xanthoxylin 

Xylen (xylol) 

Xylenol (ortho-) salicyl 

Yohimbin , 



Zinc, acetate 

bromid 

chlorid 

citrate 

cyanid 

ferrocyanid 

hemol 

hypophosphite 

iodid 

lactate 

oxid 

phosphid 

phosphate 

salicylate 

subgallate 

sulphate 

emetic 

sulphocarbolate 

tannate 

and potassium cyanid. 
valerianate 




0.4 

0.13 

0.02 

0.5 

0.015 

0.25 

0.5 

0.1 

0.13 

0.06 

0.3 

0.015 

0.3 

0.2 

0.25 

0.03 

2. 

0.25 

0.1 

0.06 

0.2 






■ 



'•.». . 



REFERENCE TO AUTHORITIES. 



Abel, 456 

Abulcasem, 21, 205 

Aldrich, 456 

Allport, 208 

An der Lahn, 515 

Andresen, 112 

Anrep, 277 

Apollonia, 20 

Archistrator, 19 

Arkovy, 23, 128, 144, 193, 206 ' 

Arnott, 444, 452 

Arrhenius, 81, 82 

Arthur, 208 

Audina, 277 

Avenzoar, 21 

Avicenna, 21, 39 

Baker, 22 

Barker, 277 

Bauer, 192 

Baumgarten, 150, 152 

Baxley, 23 

Beck, '437 

Beer, 500 

Bengue, 290 

Beresford, 294 

Bergmarm, 271 

Bern ays, 88 

Bert, 307, 309 

Berthollet, 296 

Bethel, 196 

Biberfield, 459 

Bier, 36, 153, 229, 406 

Billeter, 296 

Billon, 283 

Billroth, 315 

Binz, 18, 206 

Black, 128, 192, 198, 200 

Boening, 215 

Boerhaave, 39 

Bohm, 132, 436 

Bois-Reymond, 446, 500, 516 

Bolton, 199 

Bond, 23 

Bonnecken, 140 

Bostwick, 22 

Bouelle, 296 

Bouillon, 170 

Braddock 294 

Braun, 457, 458, 459, 480, 486, 487 

Bredig, 85 

Brodtbeck, 296 

Brooks, 192 

Broomell, 476 



Brown, 22 
Brown-Sequard, 399 
Brugsch, 18 
Brunton, 34 
Bruylant, 246 
Bryan, 195 
Buchheim, 40 

Buckley, 96, 117, 140, 141, 147, 148, 
154, 168, 217, 239, 243, 339, 489, 496 
Bunsen, 518 
Burdell, 22, 205 
Burns, 217 

Callahan, 94, 95 

Canquoin, 176 

Cardow, 445 

Carlson, 296 

Carpenter, 457 

Carson, 232, 233 

Carter, 327 

Celsus, 19, 30, 39, 205 

Chantemesse, 409 

Chauliac, 444 

Cheyne, 506 

Chupein, 192 

Churchill, 232, 233 

Clark, 192 

Clearmont, 246, 

Clemens, 500 

Coleman, 214, 303, 307 

Collier, 489 

Colton, 294 

Condy, 120 

Conrad, 192, 196 

Cook, 96, 132, 144, 158, 174, 268 

Cooley, 294 

Cordus, 295 

Cornell, 295 

Cosmus, 20 

Courtois, 230 

Cowper, 504 

Cravens, 197, 199 

Crede, 201 

Crowfoot, 294 

Cunningham, 214 

Cushny, 121, 149, 157 

Czapek, 143 

Dalma, 283 
Dalton, 298 
Damocrates, 19 
Daninger, 373 
David, 277 
Davis, 489 

581 



582 



REFERENCE TO AUTHORITIES. 



Davy, 292, 293, 297 
De Vries, 449, 450 
Didsbury, 446 
Dieffenbach, 443 
Dieman, 296 
Dietl, 39 
Dill, 420 
Dioscarides, 26 
Dobell, 99 
Dobrzyniecki, 430 
Dolci, 20 
Dorn, 128, 208 
Drake, 504 
Dun, 392 
Dunning, 205 
Dzierzawsky, 473 

Ebers, 18 
Ebn Sina, 205 
Ebner, 472 
Ehrlich, 402 
Einhorn, 283, 287 ; 288 
Ellsworth, 294 
Emmerling, 143 
Endelman, 390 
Ermold, 321 
Escat, 501 
Esculapius, 31 
Esmarch, 328, 444 
Euler, 499 

Faraday, 81 

Fauchard, 21 

Faught, 214 

Fehling, 526 

Ferguson, 320 

Filehne, 34, 207 

Finsen, 428 

Fischer, 157, 274, 287, 489, 507 

Fitch, 22 

Fitzgerald, 259, 267 

Flagg, 22, 217, 234 

Fletcher, 180, 211, 269 

Fluegge, 246 

Fourneau, 283, 287 

Foster, 205 

Fowler, 371 

Francis, 446 

Frank, 195 

Frankl, 206 

Fraser, 399 

Frerichs, 380 

Frohmann, 515 

Fuerth, 456 

Funk, 489 

Fuyt, 515 

Galen, 19, 38, 39 
Gay-Lussac, 230 
Giesel, 276, 282, 286 



Gilray, 292 
Goadby, 402 
Graham, 493 
Green, 321 
Greve, 206 
Grevers, 515 
Gross, 444 
Grunert, 132 
Gubler, 206 
Guthrie, 296 
Gysi, 140, 490 

Hackenbruch, 503, 504 
Hafner, 515 
Hahnemann, 39 
Haig, 389 

Hamburger, 407, 412, 515 
Hammurabi, 18, 445 
Hansemann, 399 
Harlan, 163, 193, 267, 270 
Harley, 315 
Harris, 23, 205 
Hattyasy, 150 
Hayden, 22 
Head, 101, 251, 391 
Hecker, 402 
Heintz, 374 
Heinz, 111, 287 
Heinze, 457 
Heller, 525 
Hempel, 373 
Henning, 290 
Herbst, 208 
Herodotus, 122 
Herrenknecht, 320 
Hertwig, 496 
Hesse, 515 
Hewitt, 302, 309 
Heyfelder, 296 
Hill, 446 

Hillischer, 277, 309 
Hippocrates, 19 
Hirsch, 170 
Hoff , 235 
Hoffmann, 39 
Hodges, 247 
Holmes, 198, 447 
Hopkins, 527 
Howard, 328, 329 
Howell, 445 
Hughes, 277 
Hunter, 253, 416, 444 
Hiippe, 96 

Impens, 288 
Ingersoll, 489 

Jack, 210 
Jackson, 295, 443 
Jenkins, 270 



? 

V 



REFERENCE TO AUTHORITIES. 



583 



Jenner, 401 
Jewett, 497 
Jodlbauer, 373 
Johnson, 489 

Rekule, 96 

Kirchner, 274 

Kirk, 46, 118, 152, 198, 211, 216, 239, 

242, 244 
Kitasato, 78, 402 
Klapp, 416 

Robert, 26, 47, 121, 271 
Koch, 78, 126, 405 
Roecker, 22 
Koerbitz, 489 
Rohler, 170 
Roller, 277, 447 
Korner, 508, 509 
Rowarsky, 227 
Rronig, 83, 84 
Ruhns, 214 
Riimmel, 21 

Labarraque, 106 

Lamorier, 504 

Laplace, 88, 96, 293, 296 

Largus, 19, 26 

Lasar, 276 

Lasser, 289 

Lawen, 457 

Lawrenz, 300 

Lederer, 501 

Lepkowski, 140 

Lewin, 506 

Liebermann, 276, 282, 286 

Liebig, 296 

Liebl, 281 

Liebreich, 34, 157 

Liecky, 292 

Linderer, 490 

Lister, 24, 122 

Lobjois, 321 

Loeffler, 489, 491 

Loew, 138 

Long, 295 

Longbotham, 22 

Lossen, 276, 286 

Lotheisen, 296 

Ludwig, 296 

Lugol, 231 

Luke, 298, 325 

Macewen, 435 

Maloney, 510 

Marcy, 294, 295 

Marion, 140 

Marti alis, 19 

Martin, 212, 309 

Massart, 408 

MaWhinney, 96, 132, 158, 159, 160 



Maynard, 205 

Mayrhofer, 105, 135, 145, 150, 436, 

437, 441, 442 
McFarland, 145 
McFarlane, 321 
Meckel, 474 
Meibom, 424 
Merling, 286 
Mesue 21 

Metchnikoff, 402, 411 
Metnitz, 212 
Metzgar, 424 

Meyer, 315, 406, 407, 413, 489 
Michel, 128, 247 
Miles 295 
Miller, 79, 80, 130, 144, 150, 158, 161, 

163, 171, 191, 195, 198, 205, 217, 246, 

252, 255, 259, 260, 268, 270, 381, 390, 

420, 492 
Minkowski, 388 
Miquel, 78 
Misch, 437 
Mitchell, 426 
Moller, 457 
Moore, 34 
Moorhof, 435 
Morgenstern, 206, 370 
Morrison, 427 

Morton, 295, 443, 447, 488, 489 
Mosetig, 435, 441, 442 

Nelaton, 327 
Nernst, 107 
Niemann, 276, 285, 447 
Niles, 195 
Nogue, 483 
Norden, 380 
Nordhoff , 483 
Notzel, 410, 411 
Novy, 252 
Nmttall, 402 

Otte, 482, 483, 484 
Ottolengui, 488, 489 
Overton, 315 

Paracelsus, 39 
Pare, 444 
Parmly, 22 
Parmly, L. B., 22 
Pasteur, 405 
Paul, 83, 84 
Pauli, 273 
Peckert, 487 
Pedley, 268 
Peso, 214 
Peters, 457 
Petri, 469 
Petsch, 500 
Pfeiffer, 402 



584 



REFERENCE TO AUTHORITIES. 



Phillips, 489 
Pierce, 192, 198, 390 
Pilchen, 435 
Pischer, 296 
Pizarro, 276 
Pliny, 19, 445 
Poliakoff, 145 
Pool, 171 
Powers, 214 
Pravaz, 44, 447 
Preiswerck, 196, 197 
Preyer, 273 
Price, 489 
Priessnitz, 410 
Priestly, 292, 296 
Prinz, 140 
Pruyn, 258 
Purdy, 525, 528 

Reclus, 459, 477, 486 

Redard, 291, 452 

Regner, 446 

Reich, 495 

Reichenbach, 128 

Remington, 47, 58 

Reni, 20 

Respinger, 296 

Reuss, 446, 495 

Rhazes, 205 

Rhein, 296, 452 

Rhyr, 445 

Richardson, 109, 289, 442, 446, 452 

Riggs, 294 

Ritsert, 287 

Ritter, 211, 408 

Robin, 106 

Robinson, 188, 321 

Rokitansky, 406 

Roland, 296, 315 

Romer, 128, 259, 486, 490 

Rose, 245, 250, 373 

Rosenbach, 274 

Rostaing, 180 

Roth, 435 

Rottenstein, 296, 452 

Ruegg, 296 

Rumford, 292 

Runge, 21, 24, 123 

Sala, 190 
Salkowski, 528 
Salter, 192 
Sauvez, 446 
Scarpa, 474 
Schafer, 34 
Scheff , 206 
Schenk, 206 
Scherzer, 276 
Scheuer, 155 
Schleich, 317 



Schmiedelberg, 40 

Schmieden, 406, 407, 413 

Schreiber, 424 

Schroder, 140, 341, 420, 499, 515, 522 

Schuetz, 172 

Schulz, 206 

Seaman, 57 

Seitz, 296, 320 

Senn, 435 

Serturner, 23 

Severino, 444 

Shanasy, 129, 195, 196 

Siebert, 140 

Simpson, 296 

Skoda, 39 

Snape, 447 

Sollman, 139 

Sorel, 180 

Soubeiran, 296 

Speier, 290 

Spiess, 274 

Spooner, 22, 24, 196, 204, 205 

Stahl, 39 

Stark, 321 

Stebbins, 195 

Sternberg, 78 

Stokes, 506 

Stolz, 457 

Strangways, 307 

Suter, 135 

Sydenham, 39 

Sylvester, 329 

Szabo, 193, 195, 210 

Taft, 192, 208, 295 

Takamine, 456 

Talbot, 178, 232, 233, 390 

Talleyrand, 63 

Taylor, 46 

Terra, 501 

Terry, 294 

Teter, 307 

Thenard, 109 

Thiersch, 93 

Thomas, 307 

Tissot, 424 

Tomes, 192, 490 

Torggler, 148 

Tousey, 515 

Trenor, 22 

Trostweijk, 296 

Truman, 193, 244 

Tuller, 489 

Uhlfelder, 288 

Van Swieten, 39 
V'ant Hoff, 449 
Velpeau, 443 
Viau, 277 



REFERENCE TO AUTHORITIES. 



585 






Vinzi, 287 
Virchow, 30 
Volkmann, 272 
Vorslund-Kjar, 488 

Walker, 77 

Walkhoff, 128, 195, 489, 493, 494, 514 

Ware, 320 

Warner, 441 

Warren, 294 

Weaver, 489, 497 

Wellcome, 465 

Wells, 25, 146, 294, 295, 443 

Westcott, 205 

Whitslar, 178 



Wiedemann, 500 

Wilbert, 57, 100 

Willcox, 497 

Winter, 300 

Witthaus, 515 

Witzel, 140, 205, 206, 277, 232, 309, 

416 
Wood, 33, 44, 204, 298, 309, 447 
Woodward, 514, 515 
Wright, 402, 403 

Young, 55, 489 

Zederbaum, 260, 489, 4S4 
Ziegler, 489 






INDEX 



Page. 

Abrasives, for the teeth 254 

Absorbents 219 

Acacia 225 

A. C. E. mixture 315 

Acetanilid 78, 397 

Aceton-chloroform 284 

Acetphenetedin 397 

Acid, acetyl-salicylic 131, 396 

arsenic 203 

benzoic 79, 130 

boric 79, 92 

carbolic 123 

carbonic 291 

china 387 

chromic 189 

gallic 183 

hydrochloric 94 

diluted 94 

lactic 187 

muriatic 94 

nitric 94, 187 

diluted 94 

nitrohydrochloric 94 

diluted 95 

osmic 189 

phenolsulphonic 96 

phosphoric 97 

diluted 97 

quinic 387 

salicylic 78, 131 

sozolic 96 

sulphocarbolic 96 

sulphuric 95 

aromatic 95 

diluted 95 

tannic 181 

trichloracetic 187 

uric 386 

vanillic 291 

Acids, as antiseptics 92 

amino 144 

oxy 144 

Acoin 282 

Aconite 338 

Addison's disease 400 

Adnephrin 456 

Adonidin 291 

Adrenalin 221, 364, 456 

Adrenin 456 

Albargin 201 

Alcohol 78, 152, 343 

methyl 153 

Alkalies 98 

Alkaloids : 33 



Page. 

Aloes 355 

Alteratives 375 

Althaea 226 

Alum 175, 220 

burnt 175 

exsiccated 220 

Aluminum, chlorid 78 

naphtoldisulphonate 179 

Alumnol 179 

Alypin 283, 288 

Aminoform 392 

Ammoniated mercury 90 

Ammonium acetate, solution of. 385 

bromid 341 

chlorid 78 

Amyl nitrite 297, 364 

Amylof orm 139 

Analeptics 342, 360 

Anemia, local 451 

Aneson 284 

Anesthesia, local 443 

history 443 

insufflation 500 

intraosseous 482 

mandibular 484 

means of producing 447 

peridental 482 

pressure 488 

pulp 488 

side and after effects 505 

subperiostal 476 

symptoms of 318 

technique of injection 471 

treatment of accidents of 325 

and penal code 505 

Anesthesin 286 

Anesthetics, general 292 

physiologic action of 315 

local 272, 459 

Anestile 452 

Anestol 452 

Anions 82 

Anodynes 334 

Antacids 236, 254 

Antiarthritics 386 

Antidolorin 314, 452 

Antifebriles 393 

Antif ebrin 397 

Antilithics 386 

Antimony, wine of 352 

and potassium tartrate 352 

Antinervins 393 

Antineuralgics 393 

Antipyretics 393 

587 



588 



INDEX. 



Page. 

Antipyrin 396 

Antisepsis 75 

Antiseptics 75, 78, 255 

strength of, in the mouth 79 

Antisialogogues. 380, 382 

Antitoxins 402 

Antizymotics 76 

Aperients 353 

Apomorphin 352 

Argentamin 201 

Argentic nitrate 190 

Argentol 202 

Argonin . _ 201 

Argyria 200 

Argyrol 202 

Aristol 104 

Aromatic series, antiseptics of. . 121 

Arsenic 371 

action of, on the pulp 205 

compounds 216 

tonic 372 

trioxid 78, 203 

Artificial dentin, Fletcher's 181 

Asepsis 75 

Aseptol , 96 

Aspirin 131, 396 

Astringents 171, 173, 254 

Atoxyl arsenate 377 

Atropin sulphate 339 

Auripigment 203 

Balsamo del Deserto 135 

Balsam of Peru 134 

Barium sulphid 189 

Betanaphtol 122, 133 

Biogen 117 

Bismuth subgallate 178 

subnitrate 90, 178 

tribromphenolate 91 

white 90 

Black's 1-2-3 128 

Bleaching agents 238 

Bleaching powder 106 

Blue stone 173 

Bone filling 440 

Bone paste 441 

Bone plombe 435 

Borax 99 

Borite 115 

Borneol 166 

Brandy 345 

Bromural 341 

Buckthorn. 356 

Burnett's disinfecting fluid 176 

Burns, ointment for 116 

Butylchloral hydrate 333 

Caffein 344 

citrated . . 344 



Page 

Calcium 373 

carbonate 236 

dioxid 115 

sulphate 226 

hydroxid, solution of 237 

Calomel 359 

vegetable 356 

Campho-phenique 127 

Camphor 166 

Cantharides 234 

Caoutchouc 224 

Capsicum 234 

Capsules 71 

suprarenal 456 

Carbolic acid coefficient 77 

Carbon tetrachlorid 314 

Cariesan 243 

Carminatives . 357 

Carnif erin 370 

Carragheen ... ... 226 

Carvacrol 122 

Carvol 166 

Cascara sagrada 355 

Cataplasms 73, 434 

Cathartics 353 

vegetable 365 

Cation 82 

Caustics,. 184 

dry 188 

iodin 233 

liquid 187 

mitigated 191 

toughened 191 

Cellulo-aceton 227 

Cement, dental, liquid for 97 

C. E. mixture 315 

Cerates 71 

Chalk, precipitated 237 

Charcoal 266 

Chinosol 78, 132 

Chloral hydrate 333 

Chlorbutanol 284 

Chloroform 78, 313 

Chloro-percha 154, 227 

Chlorotone 284 

Cholagogues 353 

Chromium trioxid 180 

Cinnabar 378 

Cinnamic aldehyd 167 

Citarin 392 

Cobalt 208 

Coca, fmidextract of 277 

Cocain 285 

hydrochlorid. ........ 275, 277, 459 

oleate ! 277 

phenate ' 277 

Cocainism 279 

Codein phosphate 336 

Cold 432 



INDEX. 



589 



Page. 

Collargol. 201 

Collodion 72, 224 

flexible 225 

Colocynth : 356 

Columbo 347 

Comminution 70 

Condy's fluid 120 

Confections 72 

Convullamarin 291 

Copper sulphate 173, 352 

Coryl 452 

Cotarnin hydrochlorid. 222 

phthalate 222 

Cotton, purified 219 

styptic 219 

Couch grass . . . . 226 

Cough mixture 368 

Counterirritation 228 

Cream of tartar 358 

Creolin 78 

Creosote 78, 122, 128 

Cresol 78, 122, 129 

compound solution of 130 

formothymol 137 

iodid 105 

Croton chloral hydrate 333 

Cuprol 174 

Cuttlefish bone 265 

Cystogen 139, 392 

Dandelion 348 

Decantation 70 

Decoctions 72 

Demulcents 223 

Dental caries, internal treat- 
ment of 375 

Dental remedies, classification of 34 
Dentin, hypersensitive, treat- 
ment of 498 

Deodorants 76 

Depilatory paste 189 

Depletives 229 

Depressants, circulatory 360 

respiratory 366 

Dermatol 178 

Dermogen 116 

Desiccation 70 

Detergents 76 

Devitalizing compounds 216 

Diabetes 390 

Diagnosis, electric, of pulp 

diseases 513 

Diagnostic aids 539 

Diaphoretics 383 

Diethylendianum 392 

Digestives 345 

Digitalis 363 

Dionin 291 

Disinfectants 75 



Page. 

Disinfection of rooms 138 

Displacements 71 

Distillation 70 

Diuretics 384 

Diuretin 386 

Dose table. 541 

Drastics 353 

Drugs, action of 31 

preservation of 37 

Dusting powder 116 

Eau de Botot 259 

Ecgonin 286 

Elixirs 72 

Elixir of vitriol 95 

Emetics 350 

Emollients 223 

Emulsions 72 

Endotoxins 146 

Epinephrin 364 

Epsom salts 357 

Ergot 222, 363 

Essential oils 155 

Ether 289, 313 

bromic 313 

sulphuric 313 

Ethyl bromid 313 

carbamate 333 

eWorld 289, 314, 454 

chlorid, administration of 319 

chlorid, local application of . . . 453 

Ethylen chlorid S14 

Ethylidin chlorid 314 

Eucain A and B 282, 287 

Eucalyptol 167 

Eugenol 79, 168, 288 

Europhen 105 

Evacuants 353 

Evaporation 70 

Excitants 342 

Expression 70 

Exsiccation 70 

Extracts 72 

Ferratin 370 

Ferripyrin 220 

Ferropyrin 220 

Ferrous carbonate 370 

sulphate 78 

Fever 393 

Fibrolysin 379 

Figs 356 

Filtration 71 

Finsen light 428 

Flaxseed 226 

Fluidextract. 72 

Fluorin 373 

Formalbacid 139 

Formaldehyd, solution of 136 






590 



INDEX. 



Page. 

Formalin ; 136 

Formamint 137 

Formin 392 

Formol 136 

Frangula 356 

Gangrene, treatment of 142 

Gargles * 72 

Gelatin 221 

paste 227 

Gentian 347 

Germicides 76 

Gland, thyroid 399 

thymus 399 

suprarenal 364, 456 

Glass, liquid 225 

Glonoin, spirit of 364 

Glossary of therapeutic terms . . 534 

Glutol 139 

Glycerin 78 

Glycerites 72 

Glyceryl, spirit of 364 

trinitrate 364 

Golden seal 363 

Gout 389 

Guaiacol 122, 129 

Gutta-percha 224 

Halogens 101 

Hand cleanser 119 

Heat 432 

Heavy metals, salts of 79 

Helleborin 291 

Hematinics 369 

Hematogen 370 

Hemogallol 370 

Hemol 370 

Hemorrhage, treatment of . 218, 221 

Hemostasin 456 

Hemostatics 217 

Hermophenyl 90 

Hexamethylenamin 137, 392 

Holocain 282 

Honeys 72 

Hops 348 

Hydragogues 353 

Hydrastis 363 

Hydrastinin hydrochlorid 222 

Hydrated chloral 333 

Hydrogen dioxid 108 

Hydronaphtol 79, 133 

Hyperemia, active 422 

artificial : 405 

congestive 415 

inducing 409 

Hypodermoclysis :-. 44 

Hypnotics 332 

Iatrochemistry 40 



Page. 

Iatromechanics 40 

Iatrophysics 40 

Iatropsychics 40 

Immunity 401 

Incompatibility 58 

example of 59 

Index, opsonic 402 

Inflammation 407 

Infusions - 72 

Injection, rhomboid 503 

Injections 72 

intramuscular 44 

intravenous 44 

Inoculation 45 

Iodids 376 

Iodin 78, 230 

Carson's paint 233 

Churchill's paint 233 

liniment 231 

tincture of 231 

Iodoform 102 

bone plombe 105 

emulsion 105 

paste 105 

Iodol 104 

Iodothyrin 399 

Ions 81 

Ipecac 353 

Ipecac and opium, powder of 336 

Irish moss 226 

Iron 369 

carbonate 370 

chlorid 370 

solution of 219 

masked 369 

oxid, saccharated 370 

perchlorid, solution of 219 

subsulphate 220 

solution of 220 

tonic 371 

Irritants 228 

Itrol 201 

Jaborandi 382 

Jalap 356 

Juices J 72 

Ealium-natrium 188 

Kava-kava 290 

Kelene 313, 452 

King's yellow 203 

Kolynos tooth paste 270 

Krameria 183 

Kryofin...... .' 398 

Lactophenin 378 

Largin 201 

Laudanum 335 

Laughing gas 296 



INDEX. 



591 



Page. 

Laxative 353 

Lead acetate 175 

Lemon juice 222 

Light, blue 291 

Lime, chlorinated 106 

Lingism 424 

Liniments 72 

Hoff's 235 

Linseed 226 

Lion's tooth 348 

Liquores 73 

Lithium carbonate 392 

citrate 392 

salicylate 392 

Lithontriptics 386 

Loretin 105 

Lotions 72 

Lunar caustic 190 

Lycetol 387 

Lysidin 387 

Lysoform 78, 137 

Lysol 78, 148 

Maceration 71 

Maglactis 237 

Magnesia, burnt 265 

milk of. 237 

Magnesium carbonate 237, 264 

citrate, solution of 358 

dioxid 117 

oxid 237 

sulphate 357 

Malaria 395 

Mandrake 356 

Manganese 370 

Marsh gas series, antiseptics of. 136 

Marshmallow 226 

Mass, blue 359 

Valet's 370 

Massage 423 

Masses 73 

Massing fluid 269 

Massolin 403 

Materia medica 26 

Medication, endermic 44 

enepidermic ....;. 45 

hypodermic 44 

Medicines, administration of . . . . 40 

Menthol 169 

Mercuric chlorid 79, 86 

iodid, red 90 

yellow 90 

oxid, red 90 

yellow 90 

Mercurol 89 

Mercurous chlorid 359 

Mercury 83 

bichlorid 86 

cyanid 89 



Page. 

Mercury, mass of 359 

nucleinate 89 

perchlorid 86 

salts 378 

subsulphate 352 

Metacresol 129 

Metallic salts, dissociation of . . . 83 

Metethyl 452 

Methylchlorid 290, 314, 452 

salicylate 169 

Methylen bichlorid 314 

Milk, sour 403 

Minnesota law decision 46 

Mispickel 203 

Mixtures 73 

Monk's hood 338 

Monochlorphenol 122, 128 

Mouth wash, alkaline 258 

antiseptic 257 

betanaphtol 134 

colors for 257 

Fitzgerald's 259 

Miller's 259 

Pruyn's 258 

Resorcinol 259 

Romer's 259 

saccharin 260 

Zederbaum's 260 

Morphin acetate 335 

compound powder of 336 

hydrochlorid 335 

solution of 336 

poisoning 337 

sulphate 336 

Mucilages 73 

Mummifying paste 154 

Mustard 233 

Myrtol 169 

Necrosis, forms of 142 

Narcotics 334 

Narcotile 314, 452 

Nargol 202 

Nervocidin 283 

Neuralgia, facial 334, 339 

Nioform 105 

Nirvanin 208 

Nitrogen protoxyd 296 

Nitroglycerin, spirit of 364 

Nitrous oxid 296 

administration of 299 

physiologic action of 298 

Novaspirin 396 

Novocain 281, 288, 459, 507 

Oak bark, white 184 

Obtundents, local 272, 280 

Oil, bay 164 

betula 162 



592 



INDEX. 



Page. 

Oil, cajuput 162 

caraway 162 

cassia 162 

castor 357 

cinnamon 79, 162 

cloves 79, 163 

eucalyptus 79, 164 

gaultheria 164 

mustard 164 

myrcia i 164 

peppermint 79, 165 

pinus pumilio 79' 

sweet birch 162 

thyme 165 

white wood 162 

wintergreen 79, 164 

ylang-ylang 165 

Ointments 73 

Oleates 73 

Oleo-resins 73 

Opium 335 

tincture of 335 

camphorated 335 

deodorized 335 

Opsonins 402 

Organo therapy 27, 398 

Orexin hydrochlorid 349 

Orpiment 203 

Orthocresol 129 

Orthof orm 284, 287 

new 284 

Osmium trioxid ' 189 

Osmosis 450 

Oxone H4 

Oxygen 113 

as an antiseptic 106 

as a bleaching agent. 240 

Oyster shells 263 

Ozone 107 

Pancreatin 349 

Papain 349 

Papayotin 349 

Papers 73 

Papoid 349 

Paracresol 129 

Paraffin , . . . . 225 

Paraf orm 137 

Paraldehyd 333 

Paranephric 456 

Paregoric 335 

Paste, Kowarsky's 227 

Penghawar djamby 219 

Pental... 314 

Pepper, red 234 

Pepsin ......' 349 

Perborate 118 

Percolation 71 

Percussion 425 



Page. 

Perhydrol 108, 223 

Peronin 291 

Petrolatum 225 

Pharmaceutic methods 70 

preparations 71 

Pharmaco-dynamics 26 

Pharmacognoscy 27 

Pharmacology 26 

Pharmacopeia : 69 

Pharmaco-therapy 26, 75 

Phenacetin 397 

Phenazon 396 

Phenocoll 398 

Phenol 78, 79, 90, 122, 123 

glycerite of 124 

ointment of 124 

phthalein 359 

salicylate 131 

sodique 127 

Phenosalyl 128 

Phenyform 137 

Phosphorus 373 

necrosis 373 

Pills 73 

blue 359 

Pilocarpin hydrochlorid 382, 384 

nitrate 382 

Piperazin 392 

Plasmolysis 449 

Plaster, mustard 234 

of Paris 226 

Plasters 73, 226 

Plugging of bone cavities 435 

Podophyllum 356 

Poisoning, acute, treatment of. . 529 

Potash, caustic 188 

Potassium, arsenite, solution of. 371 

bitartrate 359 

bromid 341 

chlorate 79, 120 

citrate 358 

hydroxid 188 

iodid 377 

ointment of 377 

permanganate 79, 119 

sodium alloy 188 

sulphocyanid 246 

and sodium tartrate 358 

Poultices 73, 434 

Powder, compound effervescing. 358 

Dover's 336 

Tulley's 336 

Precipitation 71 

Preparations for the mouth and 

teeth 245 

Prescription writing 47 

dose 55 

measure equivalents 66 

metric 50 



INDEX. 



593 



Page. 

Prescription writing, percentage 

measure 66 

solution , 66 

sample 50 

signs used in 54 

terms used in 53 

troy weight 62 

weight equivalents 66 

relative value of 62 

weights and measures 61 

Priessnitz bandage 410 

Protargol 202 

Protectees 223 

Proteins, bacterial 146 

Ptyaiogogues 380 

Purin 386 

Pseudo-solutions 85 

Ptomains 146 

Pulpcapping paste 169 

Pulp decomposition, treatment of 141 

Pumice stone 264 

Pustulants 228 

Purgatives 353 

Purgen 359 

Prunes 356 

Pyocyanase 403 

Pyorrhea alveolaris 389, 421, 402 

Pyrozon 108, 223 

Quassia 348 

Quinin sulphate 78, 395 

and urea hydrochlorid 291 

Rays, light 426 

Resins 73 

carbolized 227 

Resorcinol 122, 133 

Rhatany 183 

Rhubarb , 355 

Robinson's remedy 188 

Roborants 368 

Root canal filling materials 154 

Rubber 224 

Rubefacients 228 

Saccharin 79 

Sal Alembroth 87 

Saliformin 139 

Saline cathartics 357 

Saliva and mouth washes 250 

Salol 131 

Salt, Glauber's. 357 

Salts of heavy metals 79 

Salts of wisdom 87 

Sandarac 227 

Sandarach 205 

Sapodermin 90 

Sassafras pith 226 

Scheuer's root filling 155 



Page. 

Schreiei 's alloy 188 

Sedatives.... 340 

Seidiitz powder 358 

Senna 356 

Sepsis 75 

Serpentaria 348 

Serum therapy 400 

Sialogogues 380 

Sidonal S87 

Silver*, liquid 225 

acetate 201 

citrate 201 

lactate 201 

nitrate 78, 190 

Silverol 202 

Sinalbin 233 

Sinasin plaster 234 

Sinigrin 233 

Slippery elm 225 

Smelling salt 235 

Snake root, Virginia 348 

Soap 99 

liquid 100 

Soda, caustic 188 

Sodium anhydromethylen citrate 392 

bicarbonate 238 

borate 78, 89 

bromid S41 

chlorid 78 

diborate 118 

dioxid , 117 

ethylate, solution of 187 

hydroxid 188 

iodid 377 

salicylate 131 

silicate 225 

phosphate 357 

sulphate : 357 

Sols 85 

Solution, aluminum acetate 79 

anesthetic 461 

antiseptic 93 

Dobell's 99 

Donovan's 203 

f ormaldehyd 78 

Fowler's :.... 203, 371 

hydrogen dioxid 78 

Lugol's 231 

Monsel's 220 

Solutions 71, 73 

hypertonic 451 

hypotonic 451 

Somnifacients 332 

Somnoform 815 

Soporifics 332 

Specifics 27 

Spermin 399 

Spirits , 73 

Starch 226 






594 



INDEX. 



Page. 

Steresol • • • 228 

Sterilization 77 

Sterilizing fluid 99 

Stimulants, cerebral 342 

circulatory 360 

oral 255 

respiratory 366 

Stomach bitters, aromatic 350 

Stomachics 345 

Stomatitis, mercurial 379 

Stovain 288 . 

Strontium dioxid 117 

Strophanthus 363 

Strychnin nitrate 363 

sulphate 363 

Styptic collodion 219 

dusting powder 183 

Stypticin 222, 363 

Styptics 217 

Styptogan 120, 222 

Styptol 222, 363 

Subcutin 287 

Suramin 78, 89 

Sublimate, corrosive 86 

Sublimation 71 

Succi 72 

Suction cups 413 

Sudorifics ■. 383 

Sugar of lead 175 

Sulphonal 333 

Sulphonethymethan 333 

Sulphonmethan 333 

Sulphur 359 

Suppositories 73 

Suprarenal gland 364 

Suprarenalin 456 

Suprarenin 364 

Syphilis 379 

Syrups 74 

Talcum powder .- 119 

Talbot's glycerol of zinc lodid. . . 178 

Tamarinds 356 

Tanacol 183 

Tannigen 183 

Tannin 181 

Tannopin 183 

Tartar emetic 352 

Tartar solvent 251, 390 

Tetrachlcrmethan 314 

Theobromin sodium salicylate . . . 386 

Therapeutics, aim of 25 

light 427 

mechanical 40 

physical 40, 405 

radio 427 

Thermometric equivalents 540 

Tinctures 74 

Thymol 78, 79, 122, 169 



Page. 

Thymol, camphene 127 

iodid 104 

Thymotal 171 

Thymus gland 399 

Thyroid gland 399 

Tonics 368 

Tooth paste 269 

Bergmann's 271 

Harlan's 270 

Robert's 271 

Miller's 270 

saline . 270 

thymol 271 

Tooth powder 260 

camphor 267 

colors for 266 

Cook's.! 268 

Fitzgerald's 267 

Fletcher's 269 

Harlan's , ..... 267 

Lasar's ., ..... 267 

Miller's 268 

oxydizing 268 

Pedley's. 268 

red 268 

violet 269 

Tooth soaps 271 

Toxicology 26 

Toxins 146 

Tragacanth 226 

Transfusion 44 

Traumaticin 224 

Trichloromethan 313 

Triiodomethan 102 

Triticum 226 

Triturations 34, 71 

Troches 74 

Tropa-cocain 282, 286, 459 

Turpeth mineral 352 

Unguents 73 

Urethan 333 

Uric acid solvents 386 

Urine analysis ....;.. 523 

Urosin 387 

Urotropin 139, 392 

Valerian 342 

Valet's mass 370 

Validol ,.... 342 

Varnish, antiseptic cavity 134 

sandarac 227 

shellac , 227 

Vaselin 225 

Vasodepressors 360 

Vasodilators 360 

Vermillion 378 

Veronal 333 

Vesicants ,'..'.. 228 



INDEX. 



595 



Page. 

Vibration 425 

Vioform 105, 442 

Vinegars 74 

Vis medicatrix naturae 30 

Vitriol, blue 173 

white 177 

Water, ammonia 234 

lime 237 

witch hazel 183 

Waters 74 

Wine, red 345 

white 345 

Wines 74 

Whisky 344 

Wolfsbane 338 

Xanthin 386 

Xeroform 91, 179 



Page. 

Xerostomia 382 

Yellow wash 87 

Yohimbin 290 

Zinc acetate 181 

butter of 175 

chlorid 78, 175 

solution of 176 

dioxid 116 

iodid 178 

compound solution of 178 

oxid 179 

phenol sulphonate 79, 124, 177 

sozoiodolate 181 

sulphate 177, 352 

sulphocarbolate 177 

cement, oxysulphate 181 

Zinosol 181 



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